If there’s one thing that antivaccine activists don’t like, it’s information that doesn’t conform to their world view that vaccines are ineffective, dangerous, and cause autism, autoimmune disease, sudden infant death syndrome, brain damage, diabetes, asthma, and all manner of ailments, both acute and chronic. We learned that in Michigan when, in response to increasing rates of personal belief exemptions (PBEs) and recent pertussis outbreaks, the Michigan Department of Health and Human Services (MDHHS) instituted a regulation that required parents seeking a PBE to the state school vaccine mandate to travel to their local county health office for an educational program about vaccines before such a PBE will be issued. Also, a PBE won’t be granted unless a state-sanctioned form is used to claim it in which the parents must acknowledge that know they could be exposing their children and others to potential harm from vaccine-preventable disease. It’s been an effective strategy, and vaccine exemption rates have fallen significantly in the three years or so since the rule was instituted. The new policy has not been without resistance, of course. Local antivaxers hate it, and antivaccine groups have tried to get it overthrown. Meanwhile antivaccine-sympathetic legislators have been doing their best to make measles great again in Michigan by passing a law that would reverse the MDHSS rule while introducing all manner of bills that, if passed into law, would be likely to decrease vaccination rates, whether they realize it or not, whether that is their intent or not.
Basically, in this area, Michigan is a model for the rest of the nation. While the optimal plan would be to do what California has done and to eliminate nonmedical exemptions to school vaccine mandates, we have to face political reality. In a lot of states (probably the vast majority at this point), an SB 277-like law that would get rid of nonmedical exemptions is politically impossible. The next best thing, then, is an approach similar to what Michigan has done: Add a step that requires parents to be confronted with the potential consequences of their choice. It won’t deter hardcore antivaxers, but it clealry does sway parents who are on the fence. It also eliminates a problem with the claiming of nonmedical exemptions in which parents who might not necessarily be antivaccine would claim them because it’s easier just to sign a form than to get their children vaccinated. Unfortunately, even that modest step can run into the buzzsaw of antivaccine resistance, as has recently happened in Arizona:
The state of Arizona has canceled a vaccine education program after receiving complaints from parents who don’t immunize their school-age children.
The pilot online course, modeled after programs in Oregon and Michigan, was created in response to the rising number of Arizona schoolchildren skipping school-required immunizations against diseases like measles, mumps and whooping cough because of their parents’ beliefs.
But some parents, who were worried the optional course was going to become mandatory, complained to the Governor’s Regulatory Review Council, which reviews regulations to ensure they are necessary and do not adversely affect the public. The six-member council is appointed by Gov. Doug Ducey, with an ex-officio general counsel.
Members of the council questioned the state health department about the course after receiving the public feedback about it, emails show. State health officials responded by canceling it.
Now there’s some backbone! The backlash must have been intense. How many thousands of parents from the state complained, I wonder? Thousands? Um, not quite:
The complaints that ended the pilot program came from about 120 individuals and families, including 20 parents who said that they don’t vaccinate their children, records show.
Also, most of the emails did not specify where the parents live or where their children went to school, making it look rather suspicious that this campaign was the result of complaints from parents who don’t even live in the state. It’s just antivaxers working to make measles great again, I guess.
As for the course, it was being piloted in three Maricopa County school districts:
Carter hosted meetings attended by physicians, nurses, school administrators, school nurses, naturopaths and public health officials that led to the creation of the 60- to 90-minute evidence-based vaccine education program.
It launched in 17 schools in three Maricopa County districts last academic year. The largest share of those schools was in the Paradise Valley Unified School District.
The education program was scheduled to expand to other Maricopa County schools this academic year, and to schools in Pima, Yavapai and Pinal counties during the 2019-20 school year.
State health officials said they have returned to the drawing board regarding the regulatory duty to provide vaccine education to Arizona parents seeking vaccine exemptions.
I totally commend the process—with one glaring exception. What the hell were naturopaths doing being involved in the process leading to the creation of an evidence-based vaccine education program. Naturopaths are overwhelmingly antivaccine themselves. However, it is Arizona, home of Andrew Weil; so naturopaths are licensed, common, and unfortunately influential. Hopefully, they didn’t influence the education program too much. It appears that they didn’t.
The genesis of this program was several years ago, when a group of local pediatricians became concerned about the need for vaccine education. Then, in 2015, the Arizona Medical Association passed a resolution calling for Arizona parents who want a PBE for their children to receive public health-approved counseling that provides them with “scientifically accurate information about the childhood diseases,” including potential adverse outcomes and the risks unimmunized children pose to children who cannot be vaccinated for medical reasons. The result was this course. Moreover:
Nearly every school that participated in the pilot education program wanted to participate again, and other schools were interested in trying it, Sunenshine said, adding that schools field a lot of questions from parents that the online course addressed in a uniform, scientific way.
Dr. Rebecca Sunenshine is the medical director for disease control for the Maricopa County Department of Public Health.
In any event, the Arizona Governor’s Regulatory Review Council is similar to a legislative council in Michigan made up of legislators that reviews and either approves or rejects proposed new rules and regulations proposed by various government agencies. Unlike the case in Michigan, the Arizona Governor’s Regulatory Review Council rejected this course. Also unlike the case in Michigan, this course wasn’t even mandatory or proposed to be mandatory:
Most of the parents and others who contacted the Governor’s Regulatory Review Council about the vaccine education program were under the impression that they would be forced to take the course in order to obtain a personal belief vaccine exemption form. Many admitted they had not seen the course, but opposed it on principle.
Because of course they did. Antivaxers don’t want to have their pseudoscience bubble punctured by reality. Also, over the last several years, leaders of the antivaccine movement have been unfortunately very successful in weaponizing anti-government, anti-regulation conservatism by linking their cause to “parental rights” and “freedom,” portraying any government intervention to try to increase vaccine uptake by tightening up the requirements for PBEs or requiring education as government overreach. Sometimes the rhetoric can become quite overheated. For example, a couple of years ago, Del Bigtree, producer of the antivaccine propaganda film VAXXED, waxed full Bluto Blutarsky by invoking the Founding Fathers, ranting about how vaccine requirements were an unacceptable infringement of freedom, and how antivaxers should be willing to die for freedom.
This strategy has totally flipped the dynamic with respect to antivaxers. Traditionally, the stereotype of antivaccine parents and activists is that they’re all granola crunching hippie-dippy left wingers. As I’ve discussed many times, that’s never been true, but it was the stereotype. In reality, antivaccine pseudoscience has always been the pseudoscience that transcends political boundaries, with roughly equal prevalence on the left and the right. That doesn’t mean the most harmful variety of antivaccine activism is equally distributed between the left and right. Sadly, in 2018, the loudest and most dangerous antivaccine voices are nearly all on the right. Sure, Robert F. Kennedy, Jr. is definitely left wing and he’s antivaccine, but he’s not in government and he’s outnumbered by rightwing antivaccine politicians, all too many of whom are actual officeholders now. Indeed, my very own state senator is antivaccine, and my state representative is, if not antivaccine, antivaccine-adjacent or antivaccine-pandering. A powerful Republican Senator, Rand Paul, is openly antivaccine, while the 2016 election featured a lot of pandering to antivaccine views on the Republican side and virtually none on the Democratic side. Indeed, President Donald Trump himself has a long, sordid history of spewing antivaccine nonsense and has even met with antivaccine “icon” Andrew Wakefield.
Whatever the politics involved, it should be noted that one of the supporters of the course in the legislature is a Republican, and that’s a very good thing. As I said before, antivaccine views are not the province of the left or the right, and neither is support for vaccination:
“I’m not sure why providing ‘information’ is seen as a negative thing,” said state Rep. Heather Carter, R-Cave Creek, who spent the last three legislative sessions as chairwoman of the House Health Committee and helped create the pilot program.
“Providing information doesn’t take away a parent’s choice to seek an exemption. … This is a major concern. Vaccines have saved lives for generations. We all want to live in safe and healthy communities.”
Carter is, of course, quite correct. Providing information is not a negative thing; that is, unless you are an antivaxer who doesn’t want his or her bubble of misinformation punctured. This particular education program was, in actuality, an even more modest step than what was done in Michigan. In Michigan, it flew (barely). In Arizona, it was shot down, even though it wasn’t mandatory (although it should have been). The complaints were also quite familiar to anyone paying attention to antivaccine arguments and tactics:
More than 200 pages of emails with public feedback about the vaccine education program were obtained by The Arizona Republic. Nearly all were critical of additional steps associated with getting exemptions to vaccine requirements.
“In my experience, parents who have a personal belief against vaccines have already performed countless hours of extensive research on the benefits and risks of vaccines,” one parent wrote on July 26. “A one-sided video is not going to change their minds and therefore it is a waste of government resources as well.”
It’s probably true that a ninety minute video is not going to change the mind of a committed antivaxer who’s “done her research” through the University of Google, searching for and finding numerous sources publishing misinformation, pseudoscience, and nonsense about vaccines, but parents who are on the fence or just scared by the sorts of misinformation, pseudoscience, and nonsense about vaccines being promulgated by antivaxers might be reachable. That is exactly what antivaxers don’t want.
Then, of course, there was the fear of government helping to make measles great again in Arizona:
The course appears to be an attempt to, “create an emotional response, creating fear and pressure in order to compel parents to vaccinate,” one set of parents wrote on July 25. “Do lawmakers think we’re stupid?”
Several parents sent the same letter that said requiring them to watch a video to exercise a personal belief exemption is “an inappropriate interference with parental rights as currently defined by statute.”
First, no, lawmakers don’t think antivaxers are stupid. They are, however, without a doubt badly misinformed. Second, the fact that several parents sent the same letter is a strong indication that this was an orchestrated campaign. Yet the Governor’s Regulatory Review Council shut down the education program. Why? Sadly:
“We’re so sorry we couldn’t make a go of this — strong forces against us,” Brenda Jones, immunization services manager at the Arizona Department of Health Services, wrote in an Aug. 6 email to a Glendale school official, along with a notification about the course’s cancellation.
In an email to two Health Department staff members on Aug. 14, Jones wrote that there had been “a lot of political and anti-vax” feedback.
Unfortunately, that antivaccine activism, even though it was only 120 parents, most of whom probably didn’t live in Arizona and some of whom clearly were sending cut-and-paste emails, led the Governor’s Regulatory Review Council to cave in a most ignominious fashion. Meanwhile, the rate of PBEs in Maricopa County have surged from 3.4% to 5.9% since 2011. Truly, Arizona is setting the stage to make measles great again.