In the age of Donald Trump, vaccine policy is becoming politicized, with potentially deadly consequences (revisited)

As I sat down to lay down my daily (or at least week-daily) dose of Insolence last night, my thoughts kept coming back to vaccines. Sure, as I pointed out in yesterday’s post, we seemed to have dodged a bullet in that President Trump appears on the verge of appointing someone who is actually competent and pro-vaccine as director of the CDC. Of course, none of that changes the issue that Donald Trump’s proposed budget takes a meat axe to public health programs, including vaccines, and that if Republicans succeed in dismantling the Affordable Care Act a large chunk of money going to vaccine programs at the CDC will disappear. While it’s true that the budget was declared “dead on arrival” in Congress, the very fact that Trump proposed it lets you know what his priorities are and that they aren’t public health or medical research—or, for that matter, medical care. I joked that Trump has betrayed the antivaccine movement, having built up their hopes that he would launch bogus “investigations” into the CDC or appoint a presidential commission to look into vaccine safety, but then, like Lucy pulling the football away as Charlie Brown tried to kick it, he’s basically done nothing. Indeed, he even appointed an honest-to-goodness pharma shill whose only redeeming feature to me (that he’s pro-vaccine) is anathema to antivaxers.

Indeed, what surprised me the most about news of the appointment of Dr. Brenda Fitzgerald as CDC Director is how quiet the antivaccine movement has been about it. Sure, I cited Ginger Taylor’s appeal on Facebook to call the White House to oppose her appointment (with a hilarious response of one of her readers urging that Trump appoint antivax physician Suzanne Humphries instead and another asking what happened to his “vaccine safety commission” and lamenting his proposals to slash Medicaid that would harm special needs children) and, of course, The Gnat. Interestingly enough, one of the most rabid antivaxers, Mike Adams, is also a rising star in the alt-right and an equally rabid trump supporter. I searched his website for Dr. Fitzgerald’s name and found…nothing. Nada. Zip. News of the potential appointment broke roughly a week ago. Normally one would expect Mr. Adams to have gone on a full scale rant about Dr. Fitzgerald’s history of very strong pro-vaccine advocacy since she took over running the Georgia Department of Public Health. For any other administration, Adams would be going ballistic, with hit pieces on Fitzgerald dragging her name through the mud for her pro-vaccine advocacy.

Come to think of it, despite his having attacked Scott Gottlieb as a pharma shill ten years ago (one of the rare times he actually made some valid points), Adams has been equally quiet when it comes to Trump’s appointment of Dr. Gottlieb as FDA Commissioner. Maybe I should rub his face in these appointments. I’m not a fan of Gottlieb, but he was definitely the “least bad” option, given the libertarian free market-worshiping fairy dust sniffers who were also under consideration for the position.

Even though we’ve dodged a couple of bullets as far as vaccines are concerned, that was at the federal level. While it might give me great schadenfreude to see Ginger Taylor ranting about Dr. Fitzgerald or to contemplate the cognitive dissonance Mike Adams must be feeling as he keeps his trap shut over his hero Donald Trump’s betrayals, there is plenty going on elsewhere to give cause for concern. In my talk at NECSS a week ago, I used the example of Texas because I had written about it before, first about how it’s likely to be the next big state with large outbreaks of vaccine-preventable diseases due to its increasing number of personal belief exemptions to school vaccine mandates, and secondly about how it’s a case study in the politicization of school vaccine mandates to a level we’ve never seen before. The situation there, however, is worse than I thought. Somehow I missed this article from a couple of weeks ago (which would have been perfect for my talk) on how the Texas legislature reached a deadly stalemate on vaccines:

It was mid-April, more than halfway through the legislative session, and Texans for Vaccine Choice was finally getting the fight it had been spoiling for. On April 11, a bill to require schools to report the number of unvaccinated kids had been heatedly debated in a House committee. Doctors, public health experts, parents and others had testified in favor of House Bill 2249, calling it a transparency measure that would simply provide information about vaccination rates at individual schools. The matter was pressing, they said, because more and more parents were opting their kids out of vaccinations using a “reasons of conscience” exemption created by the Legislature in 2003. Without action, recent high-profile outbreaks of mumps and measles in Texas would only grow worse.

But Texans for Vaccine Choice has a radically different frame. While the pro-vaccination crowd appeals to legislators on the basis of science and public health, the anti-vaxxers have their own funhouse mirror version. Vaccines contain toxic chemicals, they say. They cause autism. They overwhelm the immune system. But more than that, the activists, many of them mothers, framed their position as one of parental choice and personal freedom — a message that commands attention at the Texas Legislature.

“The responsibility for my son does not fall on the state or any other family,” said one woman at the committee hearing. “And I would never rely on the herd to keep my son safe.”

Two days later, Texans for Vaccine Choice held a “Freedom Fight” rally on the South Steps of the Capitol. The event featured two prominent members of the far-right House Freedom Caucus, Jonathan Stickland and Bill Zedler, close allies of the anti-vaccination activists.

I’ve written about this bill before, which antivaxers effectively quashed this year.

Notice how the reporter, Alex Hannaford, refers to the “radically different frame.” It’s a frame that has shown up in antivaccine arguments and propaganda for a long time. Indeed, in my talk, I showed images from over 100 years ago that used very similar language. However, in the era of the Tea Party and now Donald Trump, that frame appears to have become—dare I say?—radically more effective than it was even a decade ago. That frame is to cloak antivaccine ideas in the mantle of “parental choice,” “individual rights,” and “personal responsibility.” It’s a frame that has given antivaxers plausible deniability in a way that is less transparently bullshit than the frame of “I’m not ‘anti-vaccine’; I’m a vaccine safety advocate.” It’s a frame that appeals to small (and anti-) government conservatives, libertarians, and, of course, Donald Trump supporters, some of whom are also drawn to him because of his long, sordid history of spewing antivaccine pseudoscience. (Certainly, the aforementioned Mike Adams loved this aspect of Trump.).

For example, Jackie Schlegel, executive director of Texans for Vaccine Choice has said:

Our message resonates with people. Texans value parental rights. We have a message of liberty. We have a message of choice.

She’s not wrong. At least, she’s not wrong about how framing school vaccine mandates as an issue of choice, liberty, and parental rights resonates with people of a conservative political bent, even those not inclined to antivaccine beliefs. That’s because it’s a misleading frame that completely ignores community. Thanks to the success of this frame, the stereotype of the typical antivaxer as a bunch of hippy dippy, granola-crunching left wingers is increasingly at odds with reality, if it ever jibed with reality in the first place. Increasingly, the face of the antivaccine movement is conservative and libertarian. At least the public face is, because that’s where the loudest voices are coming from right now, groups like Texans for Vaccine Choice and, in my state, Michigan for Vaccine Choice and the Michigan Vaccine Freedom PAC. Some of these are funded by powerful conservative causes. Texans for Vaccine Choice, for instance, receives support from Empower Texans, which is using the antivaccine conspiracy theorists who run the group as cannon fodder, or a “foot in the door,” in the service of their larger battle to decrease government regulation and promote far right wing causes.

In Texas, at least, this unholy alliance has produced results. Basically, Texans for Vaccine Choice has stymied nearly all efforts by the legislature to address the rising rate of personal belief exemptions. As I wrote before, it basically killed the proposed law that would have mandated school level reporting of exemption rate. (Funny how antivaxers are all for “transparency” and “more information” except when the numbers might embarrass them or when it’s information that pro-vaccine parents would like to have to help them choose a school).) Meanwhile, legislators sympathetic to the group have been introducing a flurry of bills designed to enhance “choice”:

The anti-vaxxers’ legislative agenda reflected this emphasis on “choice.” One bill, HB 1124, would’ve made it easier for parents to obtain exemptions from immunization for children in public school, reducing what was a weeklong process involving a signed affidavit to an instantly available online form.

Another proposal would’ve penalized health care providers who refuse to treat patients who won’t get vaccinated. And a third aimed to require health care providers to give parents what’s known as “vaccine excipient information” — a technical list of vaccine ingredients which, without context, can be misleading or worrisome.

Only one of the six antivax bills got a full committee hearing. Specifically, HB 1124, a bill authored by Matt Krause, a far-right member of the House Freedom Caucus from Fort Worth, would have made it easier for children to claim exemptions to immunization. Currently, a parent who wants a personal belief exemption for her child in public school must apply in writing for an exemption affidavit from the Department of State Health Services, which takes up to a week to process. HB 1124 would have eliminated the requirement for the written request by letting parents print out a blank exemption form from the health agency’s website.

Public health advocates were not wrong when they criticized the bill as a way of increasing exemption rates due to parents claiming them out of convenience. The experience in California and Michigan, as well as other states, have consistently shown that making exemptions harder to get decreases exemption rates. Indeed, in Michigan, we’ve had considerable success decreasing exemption rates by requiring parents requesting them to go to the local county health department and sit through an education program before a personal belief exemption will be granted, as well as eliminating the use of non-approved form in favor of a state-required form that acknowledges that by claiming an exemption the parent knows she might be endangering her child and others. Not surprisingly, our “freedom-loving” conservatives are trying to reverse this rule legislatively. They tried (and failed) during last year’s legislative session. They tried (and failed) this year, helped by the governor saying he would not support the bill. I’m sure they’ll try again next year. What frightens me is that one of these times they might well succeed.

Antivaxers in Texas appear to be doing the same sort of thing, and if you don’t think these are antivaxers behind the bill, check this out:

Lakshmanan [Rekha Lakshmanan, of the nonprofit Immunization Partnership] said it was astonishing that the authors of all the anti-vaccination bills were from North Texas, scene of the worst measles outbreak in years, and that three — Bill Zedler, Krause and Fort Worth Senator Konni Burton — are from Tarrant County.

Joe Lastinger, whose daughter died in 2004 after contracting influenza, told the committee, “just like restaurant workers have to wash their hands, there are lots of common-sense things we do … and anything that weakens our vaccine safety net for convenience is a mistake.”

“I’m sorry for your loss,” Zedler replied. “It’s entirely different from washing your hands — that doesn’t negatively impact anybody. But people do die as result of adverse reactions to vaccinations. And as far as flu is concerned there are people who get a flu shot and who get flu.”

“If [the flu vaccine] was as good as other vaccinations, it would be a dream come true,” Lastinger answered. “It’s imperfect but better than doing nothing.”

Krause’s bill died in committee, but pro-vaccination forces also found their proposals stuck in a legislative logjam.

Stay classy, Mr. Zedler. Stay classy.

It’s gotten really bad, too:

In the final days of the 85th legislative session, it looked like the pro- and anti-vaccine lobbies were going to have to make do with a draw. But at the 11th hour, a discussion over a bill authored by Representative Gene Wu, D-Houston, requiring Child Protective Services to give new children in its custody medical exams, suddenly turned into a feverish argument about vaccines.

Urged on by Texans for Vaccine Choice, Zedler proposed a surprise amendment that would exclude vaccinations from those checkups. Vaccines, he insisted, “do not qualify as emergency care.” He was joined by several Republican members of the Freedom Caucus, with Representative Tony Tinderholt, R-Arlington, arguing that it was an “issue of liberty.”

A plea from Representative Sarah Davis, R-West University Place, a cancer survivor, failed to move the majority of Republicans. Davis proposed a measure that would at least require foster children to be vaccinated against cervical cancer. Her proposal was defeated in a 74-64 vote. Zedler’s amendment, meanwhile, was adopted 74-58.

Though Wu’s bill died in the Senate, a similar version of Zedler’s amendment found its way onto another child welfare bill and was signed into law by Governor Abbott.

Texans for Vaccine Choice considered the session a victory, so much so that they held a victory party.

Here’s what worries me. Traditionally state vaccination policy and school vaccine mandates have been as close to a nonpartisan issue as we have in this country. There has usually been broad bipartisan support for such mandates and the idea that children should be vaccinated as a requirement to be able to attend school. It’s a consensus that has served the country well for many decades now and resulted in the near-elimination of measles and other vaccine-preventable diseases. What I fear is that this consensus is breaking down, and—even worse—school vaccine policies are becoming a partisan issue, every bit as bitter and divided as many others.

Here’s how that could happen:

Pro-vaccine lobbyist Jason Sabo is anxious that mainstream Republicans, who might ordinarily have voted against potentially harmful anti-vaccination legislation, now see it as a primary issue.

“Only the extreme of the extreme show up to vote in the primaries: the anti-vaxxers, the pro-gun people, and the anti-annexation guys. Get four or five of these groups together and you have a bloc. And it’s really smart,” Sabo told the Observer. “So next session we have a choice: We either do the same thing and get the same results, or we come back with a different strategy.”

Exactly. As antivaxers cloak their message in the rhetoric of “freedom” and opposition to “government overreach” and “government mandates,” they’re pushing the frame under which the debate about school vaccine mandates occurs to ground far more favorable to them. In the process, I fear that vaccine science is now becoming as politicized as that of climate science, such that vaccine mandates are increasingly viewed as a partisan issue. That’s how it’s become in Texas. I also fear that’s how it’s becoming in Michigan. I fear that the battles in Texas are a harbinger of things to come across the country. Worse, given the reaction of idiots like Bill Zedler to parents like Joe Lastinger, I fear that it will take more than a few deaths from vaccine-preventable diseases to reverse the madness and prod enough antivaxers to come back to their senses.