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Will Colorado be the next Western state to make it harder to opt out of vaccines?

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Emily Guerin | Apr 02, 2014 04:45 PM

Lake City, Colo, feels like a good place to escape the rest of the world. To the south, State Highway 149 winds through the San Juan Mountains over 11,500-foot Slumgullion Pass. You’re more likely to encounter a herd of bighorn sheep licking salt off the road here than an actual traffic jam. To the north, the road meanders in a narrow, often icy canyon alongside the Lake Fork of the Gunnison River. The next town is 60 miles away.

The town’s isolation conveys a sense of immunity to the problems facing much of the urbanized West. Downstream from the second largest natural lake in Colorado, there’s definitely enough water for the town’s 400 residents. And there are hardly any immigration issues, unless you count the Texans who flock here in the summers.

flu shot
A woman gets a flu shot. Courtesy Flickr user Lance McCord.

So it’s not surprising that some Lake City residents assume their isolation protects them from diseases like measles, mumps and whooping cough. Nearly 30 percent of the children in the town’s single pre K-12 school aren’t fully vaccinated – almost seven times higher than the statewide rate of 4.3 percent.

Parents are required to vaccinate their kids in order to enroll them in public school or a licensed daycare. But Colorado allows three types of exemptions: medical, religious and personal belief. In Lake City, as elsewhere in the state, the vast majority of non-vaccinated children have personal belief exemptions. A bill in the statehouse in Denver is trying to bring that number down by making it harder to fill out a personal belief exemption form – which currently only requires parents to check a box.

The growing popularity of the personal belief exemption, and the rising rates of un- or undervaccinated kids, is a concern to public health officials. Children who don’t get all of their shots, or don’t get them on the schedule recommended by the Centers for Disease Control and Prevention (CDC), are more likely to come down with vaccine preventable diseases like whooping cough than kids who are fully vaccinated on time. And to make matters worse, a 2008 study by Dr. Saad Omer, a professor of global health at Emory University who has studied vaccine exemptions extensively, found that clusters of vaccine refusal are associated with risk of whooping cough outbreaks in entire communities, not just among the unvaccinated.

Many of the most well-known clusters of vaccine exemptions are in the West. Ashland, Ore., was dubbed one of the least-vaccinated cities in the U.S. by Frontline, which filmed part of its 2010 documentary “The Vaccine War” there, after the CDC held public meetings in town to figure out why the opt-out rate was so high.

On Vashon Island in Washington state, nearly 25 percent of kindergartners have skipped at least one vaccine, similar to Ashland’s rate. In individual schools, the rate can be even higher: at the Yuba River Charter School in Nevada City, Calif., for example, 81 percent of students have personal belief exemptions.

Although these communities seem to have a lot of traits in common – progressive politics, strong environmental ethic and a back-to-the-land or homesteading lifestyle – there’s not a lot of good data on what kinds of people tend to forgo vaccination. A 2009 study showed that parents who opt out were more likely to live in well-educated, higher-income areas than non-refusers. Omer’s 2008 study of vaccine exemption clusters in Michigan found they were associated with high population density, more racial and ethnic minorities, larger families and more kids under 5 (although he says all associations except family size were “of low magnitude”).

Parents give a number of reasons for opting out of vaccination: the long-discredited theory that vaccines cause autism, concerns about unnecessary toxins in the vaccine formulas, a belief that natural, acquired immunity is superior to immunity from a vaccine, or the assumption that they are unlikely to get any vaccine-preventable diseases anyway.

It’s important to note that there is absolutely no debate in the medical, scientific community about the efficacy of vaccines. There are instances of people being injured by vaccines, but the harm they cause is far outweighed by the good they do for public health worldwide.

Now, four of the Western states with some of the highest rates of personal belief exemptions are trying to make it harder to opt out. In 2011, Washington state was the first to pass a law requiring parents to get a doctor’s signature before opting out for personal belief reasons. Since then, the state has seen its exemption rate among kindergartners drop from a high of 7.6 percent in the 2008-2009 school year to 4.6 percent in 2012-2013.

vax rates WA chart
Vaccine exemption rates in Washington state dropped after a 2011 law that made parents see a doctor before getting a personal belief exemption. Courtesy Washington State Dept. of Health.

Similar laws in Oregon and California went into effect this year. Now, Colorado’s legislature is trying to pass its own law requiring parents to either see a doctor or watch an online class on the benefits and risks of vaccines before opting out.

The bill’s sponsors say the idea is that by making it harder to opt out, it will eliminate the group of parents who think it’s more convenient to sign a personal belief than take their kid to the doctor. Dr. Irene Aguilar, a state senator from Denver who is co-sponsoring Colorado’s bill, says another goal is to make sure that people who choose not to vaccinate are making that decision based on scientific, evidence-based information.

“We like to make sure people have gotten a balanced report of what the risks and benefits are,” she says. “I think the people who strongly oppose vaccination are perhaps more swayed by some stories than what the research shows, what the data is.”

Opponents say the laws assume parents seeking a vaccine exemption are uneducated, and requiring them to see a doctor or take an online class not only undermines parental rights, but is coercive.

“When you go in for a pap smear or strep throat, does your doctor sign off on any piece of paper saying they’ve informed you of the risks and benefits and you’ve decided to say no? It’s no different. Vaccination is a medical procedure. We’re giving away our right to control what type of medical risk taking we’re deciding to take,” says Theresa Wrangham, the executive director of the National Vaccine Information Center, which describes itself as a non-profit organization that advocates for vaccine safety and does not promote or advise against vaccines. (A peek at the NVIC’s Facebook page suggests otherwise, with posts like “50 Reasons Not to Vaccinate Your Children.”)

10749084546_b7af399670_z.jpg
The outskirts of Lake City, Colorado. Courtesy Flickr user Alex Berger.

But there is a difference between a pap smear and a vaccine – cervical cancer isn’t contagious. Diseases like whooping cough are. When we talk about vaccines, we’re not just talking about personal choice, says Dr. Aguilar, we’re talking about the ability of other parents to keep their children, and themselves, safe, too.

No one is completely immune from diseases, and vaccines can and do fail. But if enough people get them, the likelihood that a disease like measles will make a comeback is pretty low. Yet as the vaccination rate drops, everyone is at a higher risk of getting sick – even people who feel protected by living a remote valley at the edge of the San Juan Mountains.

Emily Guerin is a correspondent for High Country News. She tweets @guerinemily.

Malcolm McMichael
Malcolm McMichael
Apr 04, 2014 12:34 PM
You are incorrect. There is in fact a growing debate in the scientific community about the efficacy, safety, and the long-term consequences of our large and expanding vaccine regimen - albeit mainly only among the minority not already co-opted by the drug companies or beholden to the CDC. Your blanket dismissal of doubt is merely wishful thinking that you invented without evidence or research.

There is also evidence that the whooping cough upticks are due to the ineffectiveness of the vaccine, not due to some magical power of the unvaccinated to infect everyone else anyway. So, by promoting that line without performing even basic research on your own you are merely passing on the post-hoc propaganda and fear tactics of the government agencies and monopoly drug makers. These drug makers are shielded, incidentally, with blanket preemptive liability protections (if the drugs are safe, why do they need liability shields?)

The choice to try and eliminate disease risk by injecting a litany of toxic chemicals, foreign species cultures, engineered DNA, chemical adjuncts, and disease pathogens into the developing bodies of your children is yours to make. You and your children are free to live with the consequences and side effects, if this meets your criteria for risk/benefit trade-offs then may God bless you.

However this same fear of disease, worship of interventionist chemical technology, and blind faith in drug companies and the FDA by which you are driven to partake in this chemical experiment seems to have the side-effect of rendering its adherents to declare that injecting their own children with nearly three dozen shots is not enough, they require also to satiate this fear of disease that everyone else inject their children too. Often advocating government mandate or even force if necessary.

So far, making war on your children's bodies in vain hopes of eliminating disease risk without consequence remains an option in Colorado. But not for long if people like you have your way.
Malcolm McMichael
Malcolm McMichael
Apr 05, 2014 10:15 AM
Please take a moment to read this release from the FDA - yes, that FDA. http://www.fda.gov/[…]/ucm376937.htm#.Uurd080Ju8s.facebook

It seems that instead of unvaccinated people spreading the disease to the vaccinated people, IT MAY ACTUALLY BE WORKING THE OTHER WAY AROUND. It may be the vaccinated who are making the unvaccinated sick.

Notice something else: vaccine science is not some settled "universal truth", handed down from God in stone tablets already perfect and complete. Scientists are still groping in the dark far more than they like to admit. Scientists know far less about what actually happens then you assume. Formulations change frequently. Understanding of what works and what is safe is constantly evolving. In other word: what the medical community thinks it knows often turns out to be incomplete, or just plain wrong. If you had bothered to do any actual journalism, instead of reacting from your own fear and ignorance, you would already have discovered this.

Note also that the FDA admits they don't actually know what is going on with whooping cough. They are as baffled as everyone else why their vaccine doesn't seem to be working as advertised. Note how the FDA figures that to some extent there is not a whooping cough crisis, but rather an increase in detection and reporting. But notice how they refrain from blaming the unvaccinated, because that is not what is going on.

A logical person might wonder if what the medical "state of the art" is supposedly right now, is not actually cast in stone forever, but in fact may well get turned on its head tomorrow. Therefore, a logical person might hesitate to act unquestioningly on the drug company assurances today.
Tom Schweich
Tom Schweich
Apr 05, 2014 09:35 PM

If the operative test is settled universal truth handed down from God in stone tablets already perfect and complete, then I am worried that my belief in the imperfect theory of gravity may fail me and my chair may begin to float up off the floor.
Malcolm McMichael
Malcolm McMichael
Apr 07, 2014 09:39 AM
Well Tom, get ready for a shocker, because the vaccine industry and regulators periodically change their mind about formulations, approaches, and side effects.

One particular event that leads to change results from vaccines that actually make people sick at too high a rate, which happened with polio and MMR and others. The link I provided (which you clearly did not read) makes it amply clear not only are there differing philosophies to the pertussis vaccine, but authorities are doing studies to find out why the one they followed does not seem to be working very well.

Of course, even the science of physics itself is subject to change - ideas about the nature of the universe are turned on their heads from time to time. You should pick up a book and learn about these newfangled ideas about quantums and strings and such. Luckily, the scientists themselves did not close the book on investigation after Isaac Newton or Einstein, and continued to pursue knowledge, even if cherished ideas sometimes fall by the wayside.

Where would we be if Copernicus and Galileo decided that established science was a done deal? Where would we be if the mainstream medical industry of the late 1800's had succeeded in shooting down germ theory - leaving us to bleed ourselves of ill humors?

100 years ago, many scientists and doctors enthusiastically backed the idea of sterilizing people to protect the gene pool. Well into our lifetimes, medicine dealt with mental illness by jabbing people through the eye socket to scrape at their brain.

Cigarettes were once advertised with a straight face as safe and harmless. Same for DDT. Fracking, pesticides, and Genetically Modified foods are the current poster children for industries that insist they are miracles without downsides; tested, safe, and approved for widespread use. Increasingly, people know better.

Medical science is just now discovering that maybe gut flora has a role in health, after dismissing that idea as quackery for decades - and doing its level best to destroy gut bacteria with many of the treatments it recommends.

The medical industry is now also famously coping with their overzealous use of antibiotics - leading to hundreds of thousands of stubborn often fatal hospital acquired infections every year. I am willing to bet you know more than one person that had to be readmitted after a procedure, to deal with a life altering of even life threatening infection they picked up while at the hospital. This is the direct legacy of overuse of a miracle drug that has no downside, and over-reliance on major medical interventions.

There is currently a low level scandal brewing as we learn that a shocking number of research surveys have unrepeatable results, sloppy procedures, conflicts of interest, and even fraud - and that negative results are often buried. This is not surprising when you consider that many of the studies are funded by the very companies are government agencies that benefit from positive results. It is a built-in free market mechanism recipe for bad behavior and cover-ups.

People who are skeptical about vaccines understand that medical science can be wrong, can change its mind, can do too much of a good thing, or can degrade the effectiveness and quality of its approaches over time.

The vaccine paradigm exists on a near religious pedestal. Unchallenged and unaccountable for decades. Government edicts from massive bureaucracies force people to injects their children. Regulatory bodies with major industry conflicts of interest issue recommendations that favor their benefactors. Drug companies are protected from liability with a preemptive blanket waiver. Drug companies fund the research, with voluntary reporting of results. The government provides guaranteed captive and often monopoly markets to drug makers, then protects them from liability for mistakes and malfeasance. During this time, the scaremongering and list of allegedly dread diseases that are a threat to human existence grows exponentially. Drug lobbyists and model legislation factories do what they do - getting legislators to expand their markets by government mandate.

People like me are skeptical of pesticides, and fracking and GM foods experience similar conversations with those proponents as we do with vaccine advocates. It's tested, it's approved, it's a miracle, there is no downside. In some cases, thanks to the existence of PR firms and lobbyists, it is in fact the very same people making these arguments.

Eventually, it occurs to rational people to wonder why the vaccine industry is exempt from the corruption and bad ideas that pervade all these other industries and other realms of medicine itself.

It seems important for vaccine advocates to cling to this cherished idea of an infallible benevolent vaccine industry, a miracle without downside or consequences, immune to the corruption and conflicts of interest that seem to have overtaken so many other aspects of public and economic life. That's not rational Tom, that's wishful thinking.
martin weiss
martin weiss Subscriber
Apr 08, 2014 07:51 PM
inoculation may become the price of freedom. Free passage according to disease-free status. disease control is imperative. ok, they're makin a buck, but that's the way the current paradigm works. we got rid of kings and now we have oligarchs. same old, etc. check out the new virus killing millions of baby pigs. c'mon. that's another reason to let wolves and coyotes be. when they're gone rats move in with bubonic plague.
martin weiss
martin weiss Subscriber
Apr 08, 2014 07:58 PM
and let the buffalo roam, too. re-establish a viable ecology here, without poisons. get the big picture, become a participant in the great oneness. it's not smart to mess with mother nature. if there's gonna be angels on earth it's up to us. our understanding is our best survival tool.
Lisa Niermann
Lisa Niermann
Apr 14, 2014 04:11 PM
Thank you Malcom McMichael for your thoughtful posts. I am disappointed that Emily's blog post actually made it into the GOAT Blog...non-objective, biased "reporting" at its worst. I won't waste space by iterating the valid points made by Michael, but I do want to point out that the link Emily has embedded above to cite the 'long-discredited theory that vaccines cause autism' takes you to the Science Based Medicine website which is extremist to the Nth degree in crucifying any type of alternative medicine: homeopathy, herbs, acupuncture and more. If the pro-vaxxer viewpoint was balanced by something like EVIDENCE-BASED SCIENCE, the post would be more equitable. Emily, a tiny blurb on a blog will never do this issue justice. Please take the time to do real, unbiased research and let the readers make their own decisions about what is right and wrong regarding vaccines.

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