Make measles great again? Our Michigan legislature is doing its best to bring back epidemics of vaccine-preventable diseases.

If there’s one thing about living in Michigan that is truly irritating, it is that the legislature is currently controlled by a bunch of right wing Tea Party-style Republicans, while the governor is Rick Snyder, someone who sold himself as “one tough nerd” and a reasonable centrist businessman but who’s consistently refused to stand up to the worst elements in his party. Oh, and he was also asleep at the switch, contributing to the Flint water crisis. Add to that my state senator, Patrick Colbeck, who not only has antivaccine proclivities, but “questions” evolution and, of course, denies climate science. Politically, it’s a painful place to live right now in a lot of ways.

One area, however, where Michigan has done pretty well during the last three years or so is in vaccine policy. In response to increasing nonmedical exemptions to school vaccine mandates and falling vaccination rates, as well as pertussis outbreaks, particularly a big pertussis outbreak in 2012, the Michigan Department of Health and Human Services (MDHHS) decided to do something about it. In brief, the state emulated California’s first attempt to combat the rising tide of personal belief exemptions (PBEs). Basically, starting January 1, 2015, the MDHHS altered the rules regarding requirements for parents to claim personal belief exemptions to vaccine mandates. Basically, it patterned its policy change on California Bill AB 2109, a bill from a few years ago that sought to tighten up requirements for PBEs in California. AB 2109 required parents seeking PBEs to meet with a physician or other enumerated health care practitioner to receive counseling on the risks of opting their children out of school vaccine requirements. The physician would then have to sign the PBE form to verify that he had counseled the parents. Of course, in the wake of the Disneyland measles outbreak a year ago, California passed a far stronger measure, SB 277, which, beginning with the 2016-2017 school year, eliminates PBEs in California.

Michigan State Senator Patrick Colbeck: antivaccine-sympathetic.

Michigan State Senator Patrick Colbeck: antivaccine-sympathetic.

In contrast, Michigan’s policy requires parents seeking PBEs to visit their local health department office to:

  • Be educated by a local health worker about vaccines and the diseases they are intended to prevent.
  • Sign the universal state form that includes a statement of acknowledgement that parents understand they may be putting their own children and others at risk by refusing the shots.

So basically, it’s just like AB 2109, only with more teeth. Not just any doctor or nurse will do. Parents have to visit their local health department for the counseling. It’s a creative modification to a strategy designed to make obtaining a PBE at least as difficult as getting one’s children vaccinated. Indeed, part of the problem in Michigan, as it was in California before AB 2109, is that it’s been easier to obtain a PBE by simply signing a form and sending it to a child’s school than it is to actually get that child vaccinated according to the CDC schedule. Even better, there’s now evidence that this policy works.

Not surprisingly, antivaxers absolutely hate this policy, and unfortunately there are legislators sympathetic to antivaccine views willing to pander to them. We met some of them when I discussed Del Bigtree’s foray into Michigan to visit with state legislators, the better to persuade them that “freedom” demands that parents have the ability to choose to leave their children vulnerable to vaccine-preventative diseases. In late 2015, legislators introduced HB 5126 and HB 5127, which specifically eliminates the authority of the Michigan Department of Community Health to make or enforce a rule that allows a local health official to exclude a child who lacks documentation of immunity from school when a child in that school has a communicable disease and to reverse the rule change by the MDHHS that required parents seeking PBEs to undergo counseling at a local state or county health office. Fortunately, neither bill passed.

Unfortunately, that hasn’t stopped legislators who are either antivaccine-sympathetic or antivaccine from, fresh off of celebrating the first case of measles in Michigan this year, having another go at it:

Yesterday marked the start of National Public Health Week.

This is a blog about some of Michigan’s conservative elected officials who clearly did not get the memo.

Michigan Republicans have decided to throw established science and concerns for public health out the window by introducing bills that are clearly catered to the anti-vaccine crowd — and will ultimately put the public’s health at risk.

According to MLive, “parents seeking an exemption to vaccinations must be educated by a local health worker about vaccines and sign a universal state form, which includes a statement of acknowledgement that parents understand they could be putting children at risk by refusing the shots.”

Under the proposed bills, the rule would be eliminated.

According to health officials, this rule helped drive down vaccine waivers, which led to more kids getting immunized. Data from 2015 showed that Michigan ranked 43rd lowest in the nation for immunizations covering kids from 19 to 35 months. So clearly, we still have some work to do.

But guess what? Since the rule change the state has reported a 35% decrease in the the overall PBE waiver rates. So what do lawmakers want to do? They want to screw it all up and risk backsliding by eliminating that rule, and, unfortunately, it’s a familiar name behind the effort in the state Senate, at least. Yep, it’s Patrick Colbeck:

“The rules enacted by DHHS pertaining to parents who wish to opt out of vaccinations for their children go beyond the intent of the current law, which was to inform parents of potential consequences of their choices, but now seems to have a punitive intent,” Sen. Colbeck said. “Whenever a department promulgates rules that go beyond the intent of the legislation, it is then the role of the Legislature to make sure those rules are reined back in. It was never the intention of the Legislature to see a vaccination opt-out procedure put into place that essentially mandates that parents have to take time off of work to meet with specific people, view videos, or sign inflammatory forms to exert a right they should be able to exercise more simply.

“State legislators are increasingly concerned about departments implementing rules that go beyond legislative intent. There is a strong desire to reform the administrative rule-making process across the board, thereby limiting the need for retroactive correction.”

There are two bills in the Senate (SB 299 and 300), co-sponsored by Colbeck, and a bill in the House, HB 4425, sponsored by Rep. Tom Barrett and a bunch of other Representatives, and HB 4426. Both are designed to strip the MDHHS of the authority to make a rule like the one that requires counseling by a public health official before a vaccine waiver is granted. The text of HB 4425 is virtually identical to that of its predecessor (HB 5126) (I can’t find the text of SB 299 or 300 on the Michigan website as of last night):

(2) A child is exempt from this part if a parent, guardian, or person in loco parentis of the child presents a written statement to the administrator of the child’s school or operator of the group program to the effect that the requirements of this part cannot be met because of religious convictions or other objection to immunization.

(3) THE DEPARTMENT’S AUTHORITY TO PROMULGATE RULES UNDER SECTION 9227 DOES NOT INCLUDE THE AUTHORITY TO PROMULGATE OR ENFORCE A RULE THAT IMPOSES A DIFFERENT OR ADDITIONAL REQUIREMENT FOR A CHILD TO BE EXEMPT FROM THIS PART THAN THOSE DESCRIBED IN THIS SECTION OR THAT REQUIRES THE EXEMPTIONS DESCRIBED IN THIS SECTION TO BE ON A FORM PRESCRIBED BY THE DEPARTMENT.

(4) IF THE DEPARTMENT PROVIDES INFORMATION TO THE PUBLIC ON THE EXEMPTIONS DESCRIBED IN THIS SECTION, THEN WITH THAT INFORMATION THE DEPARTMENT SHALL INCLUDE INFORMATION ABOUT THE EFFECTIVENESS AND POTENTIAL RISKS OF IMMUNIZATION FOR DISEASES FOR WHICH THE DEPARTMENT REQUIRES IMMUNIZATION UNDER SECTION 9227.

Basically, this law, if passed, would handcuff the MDCH by explicitly forbidding it from making it any harder for parents to claim a PBE than to present a signed written statement to the school administrator saying, in essence, “I don’t wanna.” You can tell the antivaccine influence in this bill by the language about the “potential risks of immunization.”

Like its predecessor, this bill is even worse than that, though. Not content to eliminate a strategy that has worked to drive down the rates of PBEs in Michigan, Colbeck and like-minded legislators in the House want to make it harder to prevent outbreaks of vaccine-preventable diseases in schools:

(2) THE DEPARTMENT’S AUTHORITY TO PROMULGATE RULES UNDER SECTION 5111 DOES NOT INCLUDE THE AUTHORITY TO PROMULGATE OR ENFORCE A RULE ALLOWING A LOCAL HEALTH OFFICER WHO CONFIRMS OR REASONABLY SUSPECTS THAT AN INDIVIDUAL ATTENDING A SCHOOL OR GROUP PROGRAM HAS A COMMUNICABLE DISEASE TO, AS A DISEASE CONTROL MEASURE THAT IS NOT IN THE CASE OF AN EPIDEMIC, EXCLUDE FROM ATTENDANCE AN INDIVIDUAL WHO LACKS DOCUMENTATION OF IMMUNITY OR IS OTHERWISE CONSIDERED SUSCEPTIBLE TO THE COMMUNICABLE DISEASE. AS USED IN THIS SUBSECTION, “GROUP PROGRAM” MEANS THAT TERM AS DESCRIBED IN SECTION 9211.

What this provision would do is to prevent a local health officer from keeping unvaccinated children out of school if a a case (or cases) of a vaccine-preventable disease occurs in that school outside of an actual epidemic. I looked at this provision, looked at it, and then looked at it again, and for the life of me I can’t figure out the rationale for this. Basically, the only purpose this provision serves is to endanger children who are not vaccinated, thanks to PBEs, while at the same time inserting additional susceptible children into an environment where a contagious disease resides, thus making an outbreak more likely. In the case of a small outbreak of vaccine-preventable disease that doesn’t qualify as an epidemic, preventing health officers from taking the reasonable precaution of keeping children not vaccinated against the disease out of school is an excellent strategy to make it more likely that a small outbreak becomes a large one—or even becomes an epidemic. By the time you have an epidemic, keeping unvaccinated children out of school becomes much less effective, as it’s a strategy that works best early in the course of an outbreak. This law, if passed, could easily produce a public health disaster. It’s utter madness, and the legislators who are promoting such policies are clueless when it comes to public health.

The stupid, it burns. It boggles the mind. It’s unbelievable. Except that it’s not. Believe me, our state legislature right here in Michigan really is that dumb and dysfunctional. We really do have a large number of legislators who conflate “freedom” with the freedom to endanger public health and fetishizes “parental rights” without even considering the rights of the child. It’s almost as though they’re trying to turn Michigan into Romania, with its massive ongoing measles outbreak. The sheer scientific ignorance and downright stupidity boggle the mind.

As Sam Inglot puts it:

This is a case where you have a handful of conservative elected officials pursuing an agenda to appease a small, ideological segment of their base for the votes, while ignoring scientists and public health experts who have the interest of everyone in mind.

Call your state rep and senator and tell them to oppose House Bills 4425/4426 and Senate Bills 299/300 because they are dangerous, anti-science bills that will only create more health dangers for the public.

And here are some handy instructions to do just that: