Vaccine Exemptions: Conference Call with Richard Pan MD and Paul Offit MD --Pt 2 of 2

Edited to give credit where credit is due:

The conference call was hosted by Amy Pisani of Every Child by Two.  I was invited to the call by Christine Vara of Shot of Prevention.

The afternoon of July 24, 2012, I had the distinct pleasure of being on a conference call with Richard Pan MD (who is also a California state representative) and with Paul Offit MD, who is perhaps the US's leading advocate for vaccine safety and efficacy¹.  The call focused on vaccine exemption issues.

What follows is not a word-for-word transcription (that will be posted at Shot of Prevention) but the gist of Dr. Pan's and Dr Offit's comments. Part 1 focused on Dr. Pan; Part 2 is Dr. Offit's remarks.

Dr. Offit focused on the language we use for vaccine exemptions.  

He began by reviewing the facts: Twenty-eight states, including Florida, Massachusetts and New York, allow parents to opt out for medical or religious reasons only. Twenty other states, among them California, Pennsylvania, Texas and Ohio, also allow parents to cite personal or philosophical reasons. Mississippi and West Virginia allow exemptions for medical reasons only.

 There are 3 forms of exemption:  

• Medical 
• Philosophical or Personal Belief 
• Religious²

Obviously, medical exemptions are valid. Two examples are allergies to eggs or gelatin, both of which are used in the preparation of some vaccines.

There are 20 states that allow a personal belief or philosophical exemption. Frankly this exemption doesn't make sense. The word philosophical is derived from philo -- the love of and sophos -- wisdom. Any one who is acquainted with the data about vaccine safety and efficacy would get the vaccines. It's hard to see where the wisdom is in the notion of not getting a vaccine is better than getting one. The other phrase, the personal belief exemption, is equally questionable. Vaccines aren't a belief-based system, they are an evidence-based system. If you want to reassure yourself about vaccine safety and efficacy, you need only to look at the research on vaccine safety and efficacy -- there are literally thousands and thousands of studies. You don't have to believe in vaccines, you don't have to believe in a person that tells you that vaccines are safe and effective, you only have to examine the data.

The third type of exemption is the religous exemption. There are 48 states in the US that allow a religious exemption. The two that don't allow them are surprising: West Virginia and Mississippi.

If you argue that your religion does not allow you to be vaccinated, the first question that comes up is, "What religion is that?" All the writings on which the major religions are based -- the old testament, the Torah, the new testament, the Koran, were all written centuries before vaccinations were invented. None of the texts even predict vaccines. Mary Baker Eddy's book, Science and Health, is the basis of Christian Science, and she does write that one should not get the smallpox vaccine as it's not a disease but a mental state, so to treat smallpox you pray. You could argue that the religous basis for refsing vaccines, frankly, just isn't there.

West Virginia and Mississippi don't allow religous exemptions because they were, surprisingly, progressive. Both states' Supreme Courts have ruled that a parent's refusal of vaccines on behalf of their children is a violation of the Equal Protection Clause of the 14th Amendment. The Equal Protection Clause essentially says that all people in the US are entitled to life and liberty, and the parent's religious belief does not trump the child's right to be fully protected from disease.

Offit pointed out that religious freedom is guaranteed by the First  Amendment, but acting on those beliefs is not equally protected.  For example, Mormons do not get to be polygamous, and the children of Seventh Day Adventists are required to receive medical attention the faith otherwise forbids, such as blood transfusions or chemotherapy.

It might make our public conversations about exemptions if we jettisoned the phrases "personal belief exemption" and (for most) "religious belief exemption" and told the truth about the people seeking them: "I read something scary on the internet that alarmed me so I want to refuse my child the protection of vaccines" exemption.  

Todd W of Harpocrates Speaks asked Dr. Offit, "Would it be useful to encourage main-stream religious leaders to speak out in favor of vaccines?"³  Offit replied (if I am remembering correctly) that Todd's suggestion was an intriguing one that he had not previously considered.  

A reporter from the Arizona Star (whose name I didn't catch) brought up adult vaccination; both Dr. Pan and Dr. Offit agreed that adult vaccine compliance is very low, and might indeed account for some of the pertussis outbreaks recently in the United States.  There's a lot to be done in educating adults about their need for pertussis boosters, particularly.

Shannon Rosa, as an autism parent who "recovered" from the false myth that vaccines cause autism, asked both Dr. Offit and Dr. Pan for a brief statement on vaccines and autism.

Dr. Offit replied (my paraphrase) "It is reasonable to ask the question.  From the parent's perspective, the child was fine, the child was given vaccines, then the child is not fine. "

Dr. Offit then recounted an experience of his wife's, who is also a pediatrician.  She was seeing an infant who was due for vaccination.  As she was preparing the syringes, before he was injected,  the infant had a seizure.  In fact,the infant went on to develop a seizure disorder.  Now if the seizure had occured after the injection, there's a huge possibility that the parent would have blamed the vaccine.

Each time a hypothesis has been proposed (MMR, thimerosal, "too many too soon"), robust  studies have been done, and the hypothesis has been refuted. 

Edited to add Shannon Rosa's twitter stream

Shannon Rosa @shannonrosa Now @DrPaulOffit talking re: #vaxfax, wants to discuss the nomenclature of vaccine exemptions because not accurate. #vaxfax

Shannon Rosa @shannonrosa The types of vaccine exemptions include Medical (all states) 2) Philosophical exemptions (20 states) 3) personal belief #vaxfax

Shannon Rosa @shannonrosa Dr. Offit says "philosophical" exemptions don't make sense because vaccines are about science not philosophy. #vaxfax

Shannon Rosa @shannonrosa When people choose not to get a vaccine, not making an "informed choice." They are making a misinformed choice, unless medical reason.

Shannon Rosa @shannonrosa Religious reasons to not get vaccinated are absurd, as vaccines were not mentioned or predicted by the Bible or the Koran. #vaxfax

Shannon Rosa @shannonrosa Religious freedom is guaranteed by the 1st amendment, but acting on those beliefs not guaranteed, e.g., Mormons do not get to be polygamous.

Shannon Rosa @shannonrosa Irrational refusal of vaccination is actually a violation of the equal protection cause of the 14th amendment. #vaxfax

Shannon Rosa @shannonrosa Parents do not have the right to make their children (or other peoples' children) martyrs. #vaxfax

Shannon Rosa @shannonrosa Pediatrician on #vaxfax call: His experience with vaccine denialists is that they seem really quite set, will AB 2109 affect them?

Shannon Rosa @shannonrosa Dr. Richard Pan says AB 2109 will make a difference because people dismiss benefits, exaggerate risks. Bill will require education.

Shannon Rosa @shannonrosa Dr. Richard Pan says parents who are dead-set against vaccination are hard to reach. But that's not the majority of parents. #vaxfax

Shannon Rosa @shannonrosa Dr. Richard Pan: We need to ensure that parents who have #vaxfax questions get answers.

Shannon Rosa @shannonrosa AB2109 means parent and health care providers have to agree re: vaccine exemption. #vaxfax

Shannon Rosa @shannonrosa RT @ShotofPrev: RT @hugmeimvaxed: “If you make an informed choice, you’ll get a vaccine every time” -Paul Offit @ShotofPrev

Shannon Rosa @shannonrosa What about adults and caregiver vaccinations? Particularly the TDaP? #vaxfax

Shannon Rosa @shannonrosa Recent WA pertussis outbreak: half were kids too young for vaccination, so contracted via caregivers/adults. Adults need to be vaccinated.

3Shannon Rosa @shannonrosa It's reasonable to ask the question about vaccines & #autism, says @DrPaulOffit. But the question has been answered. No link. #vaxfax

Shannon Rosa @shannonrosa If were were in a #vaxfax conspiracy, why would there be so much research effort in trying to see if #autism - vaccine link was valid?

Shannon Rosa @shannonrosa MT @ShotofPrev: @DrPaulOffit; 2 infants who died of pertussis at CHOP contracted it from moms who refused vaccine due to lack of knowledge

Shannon Rosa @shannonrosa @birdonthestreet That's part of what the CA bill is trying to do -- help med professionals understand patients' concerns and assuage them.

Shannon Rosa @shannonrosa We have to remember that those who can't get vaccinated (immune deficiency etc.) depend on the rest of us for protection. #vaxfax

=====

¹ A commenter at the previous post suggested that I was dishonest in not mentioning Dr. Offit's vaccine-related income.  She was incorrect in that she implied that he was continuing to receive royalties.  He is not, and hasn't been for some years.

² I was intrigued by Dr. Offit's comments so went looking around for examples of religious exemptions to vaccines.  Even Christian Science urges church members to conform to vaccination laws. 

3 See Todd's most recent post on religious exemptions from vaccines: Praying In Vain for an Exemption

Comments

[LindaRosaRN]

I would like to know specifically what Dr. Offit suggests be done about non-medical exemptions which are undermining mandates. Does he want to see policy makers to overturn them? If not that, what?

[Liz Ditz]

I think his position is pretty clear: if he were in charge, the non-medical exemptions would go. Politically, that's going to be difficult, especially here in California.