Vermont Steps Toward Improved Public Health

Vaccination requirements for entry to day care programs and schools tend to be a bit of a touchy subject among those who, for one reason or another, are opposed to immunization. They tend to view such requirements as violations of their personal rights, all the while ignoring the rights of their own children, to say nothing of the rights of the other people around them, to not be infected with diseases that can be quite serious. As I recently wrote, the state of Alaska Section on Epidemiology came out with several recommendations following a chicken pox outbreak at a day care facility, which started after an unimmunized child infected their infant sibling who attended the day care. In my post, I suggested that the recommendations did not quite go far enough, arguing that philosophical or religious exemptions should require speaking to a physician before being granted. Personally, I don't think that there should be exemptions for anything other than legitimate medical reasons, but that's a topic for another post. In the meantime, requiring discussion with a medical professional seems, to me, to be a reasonable compromise for the time being.

The issue of philosophical exemptions came up last summer, as the Massachusetts state legislature considered a proposal to add philosophical exemptions to that state's immunization laws. It's a proposal that pops up just about every year in Massachusetts and is consistently, and, in my opinion, correctly shot down. Well, it looks like the state's neighbor to the north, Vermont, is considering making its laws similar to those of Massachusetts. A bill was recently passed by the Vermont state Senate, in a vote of 25-4, to remove philosophical objections as a reason to forego immunization, leaving only medical and religious exemptions. As the bill goes to the House for consideration, there is, not surprisingly, a vocal few who see the legislation as a Bad Thing^TM.

Take, for example, Charlotte Gilruth, who wrote in to the Barre-Montpelier Times Argus with her opinion in a letter titled "'Herd immunity' is misleading". From the second sentence, her letter is a treasure trove of errors and misinformation. Before I delve into it, go ahead and click on her name above to read her thoughts. See how many mistakes you can find.

"It Takes Away Rights!"

Remember how I said that anti-vaccine activists tend to view vaccine requirements as dealing with personal rights? Ms. Gilruth wastes no time framing her argument that the bill removing philosophical exemptions is a human rights violation:

If passed, parents would be stripped of the right to informed consent for an invasive medical procedure on their children.

In her world, it seems, saying that a philosophical exemption will not be accepted prior to school entrance equals blocking parents from obtaining information about vaccination. This does not jive with reality. You see, there is this Federal law called the National Childhood Vaccine Injury Act which requires that anyone who administers a vaccine must provide a vaccine information sheet to the recipient or their parent/guardian prior to administering the vaccine. The law requires that the information include:

(1) a concise description of the benefits of the vaccine,
(2) a concise description of the risks associated with the vaccine,
(3) a statement of the availability of the National Vaccine Injury Compensation Program, and
(4) such other relevant information as may be determined by the Secretary.

The Vermont bill does not, and cannot, counter this Federal law. Parents' rights to being informed about vaccines are not being stripped away, Ms. Gilruth's claims notwithstanding.

"Herd Immunity's a Myth!", or, If Vaccines Work...

Ms. Gilruth's biggest beef, at least in her letter, appears to be with the concept of herd immunity. She states:

[P]eople are quick to blame outbreaks of contagious diseases on those who are unvaccinated for a given disease. This happened when the cases of pertussis (whooping cough) were being diagnosed this winter here in central Vermont.

In reality, the great majority of those who become infected in most pertussis outbreaks have already been vaccinated for the disease.

This idea, that the majority of individuals in an outbreak are actually vaccinated, rather than unvaccinated, is one that those opposed to vaccines enjoy bringing up. Basically, it boils down to "if vaccines work, then why do the vaccinated still get sick?" On its surface, it seems like a good question. But it fails to recognize a couple details. First, falling victim to the Nirvana fallacy, essentially believing that if something works, then it works 100%, and since some vaccinated still get sick, then they must not work at all, they do not realize that while most will be protected, there will still be a small portion for whom the vaccine just doesn't work. The second error in play is the failure to consider the numbers involved. In most areas of the U.S., vaccinated individuals significantly outnumber those who are not vaccinated.

For example, if you have 1,000 people who are all old enough to be vaccinated with a vaccine that is 80% effective and 5% refuse the vaccine. In an outbreak where the disease prevented by the vaccine spreads to 20% of the population, you'd end up with 38 vaccinated individuals and 10 unvaccinated individuals who are infected. With only those raw numbers, it seems like the vaccine is useless. But when you add in the denominator, you find that those 38 vaccinees that were infected represent 4% of all vaccinated people (38/950), while the 10 unvaccinated infected represent 20% of all unvaccinated people (10/50).

Although the raw numbers in an outbreak might make it seem like you're more likely to get infected and become sick if you are vaccinated, the reality is that the vaccinated are significantly less likely to be infected.

"Natural Immunity Is Better!"

After attacking herd immunity and suggesting that vaccines are useless, Ms. Gilruth next turns to the ol' "natural immunity is better than vaccine immunity" trope:

Immunity conferred by immunization usually fades by five to 10 years after a shot, whereas permanent immunity is achieved only after natural infection. This means that herd immunity can’t exist now and hasn’t existed for at least 50 years, because the majority of the American population is baby boomers, whose protection from childhood vaccines wore off decades ago.

First, let's get one thing out of the way: herd immunity is not only being immunized. It is the combination of those who are immune from vaccination and those who are immune due to having been infected, if the disease produces lasting immunity. Which brings us to the meat of why her statement is wrong. Starting with pertussis, since it's the disease she brought up, natural infection does not provide lifelong immunity. Surviving a pertussis infection will provide immunity, but only for about 4-20 years. While this is longer, on average, than the 3-12 years of immunity from the vaccine, natural infection also carries with it the risk of complications, including increased susceptibility to other diseases.

Then there are those diseases which only produce permanent immunity by killing you, like tetanus. Surviving a tetanus infection does not produce lasting immunity at all, while the vaccine provides immunity that lasts about 10 years. And, of course, there are vaccines which do provide lifelong immunity, like the measles vaccine.

In every case where we compare the risks and benefits of the currently approved vaccines to the risks and benefits of the diseases that they prevent, the balance comes down squarely in favor of the vaccines. In large part, this is due to the vaccines' ability to induce immunity to the diseases without suffering all of the negative complications that come with infection. While adverse reactions to vaccines can occur, the occur at rates that are orders of magnitude rarer than complications from the diseases they prevent (e.g., risk of encephalopathy is about 1 in 1,000,000 from the MMR vaccine, while the risk is about 1 in 1,000 from being infected with the measles virus).

In Conclusion

This is Charlotte Gilruth's conclusion, based on erroneous reasoning and flawed logic:

The argument of vaccine-induced herd immunity is flawed and does not justify an attack on parents’ rights.

She failed to demonstrate that herd immunity is "flawed" and also failed to show how removing philosophical exemptions is an attack on parents' rights. Her argumentation in this letter demonstrates a lack of rigorous, scientific reasoning and logic. (As an aside, my opinion of her reasoning abilities has since been reinforced by finding out that Ms. Gilruth is also a homeopath.)

Philosophical exemptions, in far too many cases, provide a means for getting out of vaccine requirements for, quite simply, stupid reasons. It can encompass everything from "I'm ideologically opposed to vaccines" to "I read something scary on the internet" to "I just forgot to take Jimmy in to see the doctor". For anti-vaccine advocates, philosophical exemptions empower selfishness and a disregard for the well-being of their children and the well-being of the people in their community. I have yet to see a legitimate philosophical reason to opt out of the vaccines that are required to enter schools and day care, where a large number of individuals come into regular, close contact with each other, a prime environment for disease transmission.

I applaud the Vermont state senators who voted in favor of eliminating the philosophical exemptions, and I sincerely hope that the state representatives and governor follow the Senate's lead. And, should the bill fail, I hope that, at the very least, those seeking philosophical exemptions will be required to discuss their decision with a medical professional first.

If any of my readers live in Vermont, please contact your senators to applaud them (if they voted for the bill) or to express your disappointment (if they were one of the 4 that voted against the bill), as well as to encourage your representatives to uphold public health and pass this bill (PDF).