Concern rises about vaccination exemptions, as infectious diseases spread

kidshot-300x292As outbreaks of preventable infectious diseases rise to concerning levels, doctors, regulators, and lawmakers may need to toughen important laws requiring youngsters to be inoculated, protecting better our collective health and closing off legal loopholes for sketchy vaccination exemptions.

It would be ideal if more than a century of lifesaving experience and decades of rigorous scientific research were sufficient to persuade parents to get their children vaccinated against an array of harmful and dangerous infections. But grownups’ hesitancy or rejection of shots, out of unfounded personal belief or due to medical disinformation, has set in and spread. This has undercut local, national, and global campaigns to rid humanity of contagions like measles. Public information campaigns and evidence-based persuasion hasn’t worked as well as experts might hope, leading officials to pass vaccination laws.

But those protective measures have been eroded by the exploitation by a few, so far, of well-intentioned exemptions, reporters for the independent, nonpartisan Kaiser Health News reported.

In California, anti-vaccination parents have latched on to doctors willing to grant exemption from a state law requiring kids to get specified shots to attend school. The doctors “are wielding that power liberally and sometimes for cash: signing dozens—even hundreds—of exemptions for children in far-off communities,” KHN reported.

The exemptions are rising, although, medically speaking, they should be rare, the health and medical news service reported:

Based on widely accepted federal guidelines, vaccine exemptions for medical reasons should be exceedingly rare. They’re typically reserved for children who are allergic to vaccine components, who have had a previous reaction to a vaccine, or whose immune systems are compromised, including kids being treated for cancer. Run-of-the-mill allergies and asthma aren’t reasons to delay or avoid vaccines, according to the U.S. Centers for Disease Control and Prevention. Neither is autism or fear of autism. Before California’s immunization law took effect, just a fraction of 1 percent of the state’s schoolchildren had medical exemptions. By last school year, 105 schools, scattered across the state, reported that 10 percent or more of their kindergartners had been granted medical exemptions. In 31 of those schools, 20 percent or more of the kindergartners had medical exemptions.

KHN looked at doctors writing vaccination exemptions. There is, for example, a Santa Rosa MD, trained as a psychiatrist and operating an anti-aging clinic. State officials say he has “written at least 50 exemptions, using nearly identical form letters, for students in multiple communities …saying that immunizations were ‘contraindicated’ for a catchall list of conditions including lupus, learning disability, food allergies and ‘detoxification impairment.’”

The article also notes that Voice of San Diego, an online local news site, has identified a local MD who has written 141 exemptions, “nearly one-third of all 486 medical exemptions from vaccinations for the entire San Diego Unified School District since June 2015, according to vaccination records.”

In Oregon, where health officials are battling a measles outbreak, it is nonmedical exemptions—personal or religious—that have caused concern. Oregon recorded 31,000 nonmedical vaccination exemptions, hitting the highest rate among kindergartners in the nation, KHN reported. Under state law, officials had no choice but to approve almost 30,000 of the exemptions after parents watched a 20-minute online video, then printed out their own forms to present at school. Officials noted that applicants have given phony names (Mickey Mouse) and used the system to berate doctors and vaccination requirements.

State lawmakers have talked about toughening the law, perhaps even eliminating nonmedical exemptions, as have California, Mississippi, and West Virginia. But that idea has provoked angry responses, and it’s unclear if more rigorous vaccination laws will be put in place.

In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damage that can be inflicted on babies and children in medical care. No parents want to see their youngsters sick or even to die from preventable diseases. The reduction or even eradication of infectious childhood illnesses has been a major medical accomplishment, experts say. But that progress, as well as our collective health, is at risk due to unfounded fear and suspicions, as well as rejection or hesitation, about inoculations.

Vaccinations, like all medical treatments, are not risk free. But their benefits far outweigh their risks, and they play a huge part in protecting the health not only of youngsters but us all. Their maximum effect occurs only when vaccination thresholds are reached, so communities enjoy “herd immunity,” a shared and amplified protection against disease. Depending on the illness, 90-plus percent of youngsters in a school may need to be vaccinated for herd immunity to work. That also means that exemptions need to be rare and few.

California health and medical licensing officials have said they will be scrutinizing medical exemptions for vaccination in the Golden State. But only one doctor, so far, has been subject to professional discipline by licensing authorities for not only granting exemptions but also for his opposition to vaccination.

We can do better. Doctors, lawmakers, and regulators need to hold a firm line on vaccinations to protect us all. Sure, by analogy, any grownup can be free to stand outdoors and light matches, one by one. But if they flick them into a dry grassy pasture next to a town, well, there are laws about that.

By the way, get those recommended shots yourself and get them for all your loved ones, too.

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