Poking a Wasp Nest

A couple weeks ago, I wrote about two bills that had been introduced in the Vermont House of Representatives, H.114 and H.138, that would improve public health by tightening up religious and philosophical exemptions in public schools and, in the case of H.114, child care facilities. The first bill was introduced as a result of the pertussis epidemics going around the country, with Vermont being the second-hardest hit in 2012, with 100.4 cases per 100,000 people, roughly 7.5 times the national average of 13.4 cases per 100,000 people. This outbreak was driven by several potential factors: waning immunity in teens (necessitating an additional booster), possible mutations in the bacteria (rendering the vaccine less effective), pockets of low vaccine uptake (e.g, a 13.16% overall opt-out for philosophical reasons among kindergarteners [Excel file] in Vermont private schools in the 2011-2012 school year, and a 9.73% opt-out among middle schoolers), and adults whose immunity had waned (nationally, adults have historically had poor pertussis vaccine uptake). The second bill focuses on keeping herd immunity at necessary levels within public schools, by implementing temporary bans on religious and philosophical exemptions on a vaccine- and school-specific basis when immunization rates fall below 90%.

As I mentioned in my previous post, both bills face an uphill battle. Some legislators, like Rep. Mike Fisher, chair of the House Committee on Health Care, and gubernatorial appointees, like Health Commissioner Harry Chen, seem not to want to deal with the headaches that come part-and-parcel with the topics of immunizations and exemptions. Last year, they got an earful from individuals opposed to vaccines, resulting in the blunting of a bill that took a small step toward improved public health. This year does not look to be much different, as the same people, the Vermont Coalition for Vaccine Choice, are once again rallying their forces to lobby legislators to oppose these bills.

This Wednesday, February 27, they will be sponsoring a public talk at the Fletcher Free Library in Burlington. Their featured speakers are physician-turned homeopath, Dr. Horace O. "Sandy" Reider, chiropractor Heather Rice, DC, Jennifer Stella (also a homeopath) and Deborah Kahn. They have also been supported by Barbara Loe Fisher and the National Vaccine Information Center, with recent vocal support from the NVIC's New Hampshire Director of Advocacy, Laura Condon.

Now, the Vermont Coalition for Vaccine Choice does not particularly care for me. They became aware of me after I commented on a pair of op-ed articles on the Vermont Digger. As a result of my addressing their misinformation, they asked on their Facebook page who I was and who was paying me:

Because caring about public health isn't enough, I must be a shill.

Nope, couldn't possibly be doing this on my own; I must be funded to write.

Don't bother looking for my comments over on the Digger, though. The editor removed them when I refused to identify myself, even though I explained why (see, for example, this account and this account of what anti-vaccine activists have done to others). With a group like VCVC gunning for me, little wonder I'm a bit cautious about exposing my family, friends, and employer to potential harassment. A few other science-minded types voiced their protest and have miraculously not been deleted (yet), but to no avail. Nor has the editor responded to my requests to have what I had written sent back to me, which is disappointing, since I'd put a fair bit of time, effort and research into them. It would appear that the Vermont Digger's editor, Anne Galloway, places more value on the appearance of civility and illusions of etiquette, rather than the actual content of posts. [Edited to Add: After a few more email exchanges with Ms. Galloway, she claims she's unable to copy/paste my comments into an email to me, and she refuses to temporarily restore them so I can save a copy of them myself, even though I suggested removing them again as soon as I have let her know that I saved a personal copy or after 24 hours, whichever came first.] At any rate, Galloway made VCVC's day:

Thanks for censoring Todd's inconveniently fact-based comments.

At any rate, what kind of information, then, are people likely to encounter at this talk on Wednesday? Let's take a look at the VCVC web site to see what level of adherence to science and logic they display.

Like other anti-vaccine organizations, they exploit the death of Kaylynne Matten to spread fear about the flu vaccine. Kaylynne died 92 hours after receiving her seasonal flu vaccine. First, let me say that the Mattens have my utmost sympathy for their loss. I cannot imagine what it is like to lose a child so suddenly. But other than confusing correlation with causation, is there anything to the claim that the vaccine was responsible? Let's put a few more facts out for consideration. According to Kaylynne's mother, at the time that she got the vaccine, she also had a parainfluenzavirus type I infection. Despite the similar names, parainfluenzavirus is not influenza virus. News reports at the time stated that the toxicology report showed that a virus of unknown type had invaded her heart and caused myocarditis, which contributed to her death. Since then, it has been reported that the coroner stated that the parainfluenza infection was the cause. Parainfluenzavirus is just one of many viruses that can cause myocarditis. Furthermore, the Vaccine Safety Datalink has failed to find an increased risk of myocarditis following seasonal influenza vaccination, despite looking at four different types of vaccine (monovalent inactivated vaccine, trivalent inactivated vaccine, live attenuated monovalent vaccine and live attenuated trivalent vaccine) in 9.2 million children and adults. While it is certainly possible that the vaccine played a role, it is more likely that the parainfluenzavirus or some other unknown virus caused her death.

Another tidbit you will find on the VCVC site is the myth I discussed not too long ago that Barbara Loe Fisher has also promoted: the erroneous claim that vaccine manufacturers face no liability. As I discussed before, this is untrue. Briefly, liability claims against a manufacturer come in three flavors: design defect, manufacturing defect, and labeling defect claims. Individuals are allowed under current law to sue a manufacturer directly for manufacturing and labeling defects. Design defect claims, however, are preempted by the National Childhood Vaccine Injury Act of 1986. The act was set up to provide rapid compensation to vaccine-injured parties at a lower threshold than in the tort system, while also protecting the vaccine supply from frivolous lawsuits. Furthermore, this only applies to vaccines that are on the recommended childhood schedule. So for design defect claims for injuries following recommended childhood immunizations, petitioners must go through the Vaccine Court first. They can appeal the decision, claiming the court made a mistake, or they can reject the decision and seek damages in civil court. Manufacturers, for their part, must pay a fee into the program for every single vaccine they produce.

On the same page discussing manufacturer liability, the folks at VCVC also seem to misunderstand the Vaccine Injury Table. Under the heading "So how do we determine if an injury was caused by a vaccine?", they write:

The US Department of Health and Human Services/ Health Resources and Services Administration (“HRSA”) keeps a list of compensable vaccine injuries. The list is rather narrow and is also used as a basis for “contra-indications” which would lead to medical exemption from vaccination policies. According to HRSA,

“The Vaccine Injury Table (Table) makes it easier for some people to get compensation. The Table lists and explains injuries/conditions that are presumed to be caused by vaccines. It also lists time periods in which the first symptom of these injuries/conditions must occur after receiving the vaccine. If the first symptom of these injuries/conditions occurs within the listed time periods, it is presumed that the vaccine was the cause of the injury or condition unless another cause is found. For example, if you received the tetanus vaccines and had a severe allergic reaction (anaphylaxis) within 4 hours after receiving the vaccine, then it is presumed that the tetanus vaccine caused the injury if no other cause is found. If your injury/condition is not on the Table or if your injury/condition did not occur within the time period on the Table, you must prove that the vaccine caused the injury/condition. Such proof must be based on medical records or opinion, which may include expert witness testimony.”

Unfortunately, the list is very short and narrow in terms of timeframe for reaction, ignoring the possibility of long term sequelae or chronic conditions which may develop.

The way I read this, it seems as if they are implying that the only injuries for which a person can be compensated are those that are on the table. I wonder if they really read the bit they quoted. If someone suffers an injury that is on the table within the timeframe indicated, then it is presumed that the vaccine was the cause. The petitioner does not need to prove causation, and they are automatically awarded compensation. For an injury that is not on the table or that occurs within some other timeframe, compensation is still available to the petitioner, but they must prove that, more likely than not, the vaccine was the cause. And, unlike civil court, they need not adhere to the Daubert Standard for scientific evidence.

So what do they have to say about the legislation currently up for debate?

H138 proposes to hand decision making power for forced vaccination of of all SCHOOL ENROLLEES, ADULT EMPLOYEES AND VOLUNTEERS  from our elected legislative body to the Department of Health.

I don't know about you, but when it comes to decisions about public health and medicine, I place greater trust in health professionals (physicians, epidemiologists, medical researchers, etc.) than I do in legislators (predominantly lawyers and businessmen). The use of all-caps and "ZOMG the horror!" of this aside, H.138 does not change authority at all. Current immunization law in Vermont already grants authority to the Department of Health to make decisions regarding required immunizations for school or daycare enrollment.

They also object to the provisions in H.138 and H.114 requiring adults who work in public (but not private) schools and, for H.114, childcare facilities to be immunized:

Also – if you teach at a school and do not wish to have your vaccination status tied to your employment, YOUR MUST CONTACT YOUR LAWMAKER and the VT NEA TODAY to oppose H114.

In other words, if you want to abdicate responsibility for making your workplace safer for your clients (the students), complain to your lawmakers. I presume the shouting helps get the point across more clearly. A couple thoughts about this. First, immunizations will only be required for adult employees if the vaccination rate for a specific vaccine falls below 90% at their school. If the rate stays above 90%, then they can continue to eschew protecting themselves and their students from disease. If the rate for, say, MMR falls below 90%, then they would need to show that their immunity to measles, mumps and rubella is up to date. If not, then they'll need to get the MMR and only MMR, assuming all other vaccine uptake rates at the school are above the threshold. It is not clear from the bill whether those refusing immunization will actually be fired or just put on leave until rates improve. Second, they encourage educators to oppose reasonable measures to improve the safety of Vermont's public schools. This is akin to encouraging construction workers to oppose legislation requiring them to use safety cables or barriers to prevent injury to themselves and others. If you are an employee of a public school, funded by the state government, which has a responsibility to protect those in its care, then you have a responsibility to adhere to the measures they deem appropriate to ensure the safety of the children. If you don't like that, you have the option to find employment at a private school or perhaps seek a job where you needn't worry about others and can focus on yourself.

Then, in case the ALL CAPS didn't work, how about some bold underline?

Your fundamental right to make health choices for yourself and your family are at stake.

Except that right is not at stake. If you want to reject immunization, you have that right. That is not being taken away. Just understand that if you make that choice, then your child cannot attend public school. You can still homeschool them or send them to an independent school that caters to your proclivities. With the first option, you and your child are less likely to be exposed, so you won't be greatly increasing the risk to yourselves or others. Choosing the second option, however, increases the risk to your child and your community, since there will be lower herd immunity and, thus, greater risk for infection and outbreak. You have choices. You might not like them, but you have them. What the Vermont Coalition for Vaccine Choice advocates is responsibility- and consequence-free choice.

I strongly encourage science-based individuals to attend the public talk on Wednesday if you are in the area. Judging by how this group has presented information in the past and how quick they are to cry "Shill!", I imagine that your comments and questions would be a very important addition. If you go, be polite, and don't be afraid to be firm. Here are the details:

When: Wednesday, February 27, 6pm-8pm
Where: Fletcher Free Library, 235 College Street, Burlington, VT, 05401