House bill aims to bring awareness of non-vaccination consequences

Stock image | St. George News
Stock image | St. George News
Stock image | St. George News

ST. GEORGE — Not everyone chooses to immunize their child, and a bill introduced by Rep. Carol Spackman Moss, D-Holladay, aims to educate Utahns who forego immunizations on the consequences of an outbreak.

House Bill 221, titled the Immunization of Students Amendments, if passed will amend current law to require parents who elect to opt out of immunizations to not only take an online education course but to also create a concrete plan of action in case of an outbreak.

Dave Heaton, public information officer for the Southwest Utah Public Health Department, said that falling vaccination rates can largely be attributed to the now-debunked 1998 report by Andrew Wakefield claiming a link between the MMR (measles, mumps and rubella) vaccine and autism. Wakefield published the paper in the prestigious British medical journal The Lancet. Wakefield’s research was later shown to have been fraudulent, causing him to lose his medical license and forcing The Lancet to issue a rare retraction.

There is a lot of misinformation about vaccines, Heaton said, and much of it stems from the Wakefield report.

They retracted his study, but a lot of people didn’t hear about that. They still hear the effects of his original study linking vaccines with autism and there’s simply no proven link,” Heaton said. “So a lot of parents concerned about their kid’s health have that misinformation … and feel like if they vaccinate their child they might be putting their health at risk, (when) rather the opposite is true.”

“Vaccines are very common, very safe medical intervention. It’s preventative medicine,” Heaton said.

Rep. Moss said in a news release that nearly 400 individuals in Utah were exposed to measles last year during an outbreak.

“In case another outbreak occurs, this module will help parents to identify the signs and symptoms of vaccine-preventable diseases,” Moss stated in the release. “It also gets them to start thinking about, ‘what if my child falls ill; how do I prevent them from falling behind in school, or will my work allow me to take time off?’”

Herd Immunity

A chart showing how "herd" or "community immunity" works. | Image courtesy of, St. George News
A chart showing how “herd” or “community immunity” works. | Image courtesy of, St. George News

So-called herd immunity, or community immunity, according to is when a population has enough people immunized that it conveys a level of protection to those who, for a variety of reasons, cannot be vaccinated because the chance of an outbreak is greatly reduced.

With falling immunization rates, herd immunity is in danger of being lost in parts of Utah, according to a report released by the state. The report studied in detail the immunization rates of both Utah school districts and individual schools for the 2014-15 school year.  The report said that approximately 23 percent of the schools in Utah have fallen below the herd immunity threshold (92 percent vaccinated) for measles.

Cedar City graphic designer Stephanie Flores was originally against vaccines, but later came to have a change of heart when she attended grad school in Indiana.

“I was raised in a home that didn’t believe in vaccinations,” Flores said. “I was brought up with this kind of belief that they were evil. It was like a religious thing.”

It was easier to feel immune from the possible effects of an outbreak living in a small community like Cedar City, Flores said. It was when she moved to attend grad school at the Indiana University at Bloomington that she began to have a change of heart. Indiana law did not allow her to attend the university without being vaccinated, so she delved more deeply into understanding vaccines.

It was the combination of educating herself about the science behind vaccines and seeing how easily a disease could spread in a larger population that helped persuade her to vaccinate herself and her children, Flores said.

“Bloomington is not an isolated community. You get to a certain point when you are traveling east where it is no longer … cities surrounded by uninhabited land, it’s pretty much non-stop people all the way to the east coast. The population … is so immense.”

Those large populations were obviously at risk for an outbreak, Flores said. Being a part of that community, she did not want to risk her children to an outbreak or be party to spreading possible contagion, she said.

Lacy Eden, nurse practitioner for Wasatch Pediatrics, said certain segments of the population cannot, for a variety of medical reasons, be immunized. Very young children, people with compromised immune systems, particular diseases or disorders and those who have recently undergone organ transplants are some examples of those who cannot be immunized.

This bill is important to get passed because exemption rates in Utah are rising,” Eden said, “and with rising exemption rates, we lose the protection of herd immunity. With that decreased herd immunity we have increased risk for disease outbreak.”

“The biggest threat right now is measles,” Eden said. “We are seeing outbreaks already with measles, and it’s highly, highly contagious. Because it’s highly contagious, it requires a higher percentage of the population to be immunized.”

According to the Utah Department of Health, parents wishing to claim an exemption have three options: medical, religious and personal. They must also have an exemption form signed by the child’s personal physician and the form must be filed with the child’s school or early childhood program.

Utah state law mandate that students have a certain number of vaccinations upon entering kindergarten, Heaton said.

“What happens is, if enough people don’t get immunized at that age it opens up even greater risk of these diseases re-emerging. A lot of people in the United States don’t have a memory or a concern of things like pertussis or measles because they’ve been virtually … conquered in the country.”

In other parts of the world, however, diseases like whooping cough and measles are still very much rampant, Heaton said.

Considering the numbers of nonimmunized children in the state, Moss said, the consequences of a major outbreak could be catastrophic. She said:

The total number … which includes 32,000 children who are not immunized because their parents have decided to opt them out, we have 51,000 infants between infancy and 12 months who can’t be immunized and we have … toddlers who haven’t had the full immunization schedule and then we have some medical exemptions which are fairly low in number. Add those all up and we have 87,000 children who are at risk because they haven’t been immunized.

“The bottom line is,” she said, “our immunization rate is dropping to a level that our public health officials and doctors are very concerned about. It’s a very disturbing trend.”

What the bill does

Stock image | St. George News
Stock image | St. George News

If parents want to get an exemption, the new law proposed would require them to complete an online module, Eden said. It is not an attempt to persuade them to change their mind. Rather, it is there to educate them about signs and symptoms of communicable diseases, how to protect their unvaccinated child from an outbreak and how to decrease the spread of infection within the community.

“I feel like that is important,” Eden said, “because with the decreased herd immunity and increasing rates of exemption, parents need to know how to protect their children.”

Parents who opt their kids out of immunizations often don’t realize that in the event of an outbreak, their children are mandated by law to remain out of school for up to three weeks or more, Moss said. The education module seeks to educate those parents about consequences such as this.

The purpose of the education module is not necessarily pro-vaccination, it’s pro-prevention. There’s a big difference,” Moss said.

Flores said she thinks the education module is a good idea.

“I absolutely feel that people should be educated in their choices,” she said. “I understand why they wouldn’t want to vaccinate, but why would you … decide not to educate yourself about possible outcomes of not vaccinating and then have a plan in place to react if something were to happen.”

Another provision of the proposed law would ease the grace period for children with incomplete immunizations or those who lack their immunization records.

“This will give parents the time to complete the immunizations or to obtain their records … it will allow them to be conditionally enrolled,” Moss said.

Sometimes parents will register their children for school and find their records are missing or their child’s shots are incomplete, Moss said. As the law stands currently, those children could be denied enrollment. Moss’s proposed amendments would establish a grace period for such circumstances.

“With my bill, they’ll have 21 days to do that,” Moss said.

History’s Lessons

Utah only has to look to the recent past to realize the devastating effects of an outbreak, Moss said. In 2011, a family flew to Poland to retrieve a missionary when one of their unimmunized children contracted measles. The end result was a price tag of over $200,000 to contain the outbreak and numerous missed days of school for both teachers and students.

Jeffrey Eason, epidemiologist for the Utah Department of Health, said a more recent, nationwide measles outbreak that began in Disneyland in December 2014 had severe ramifications for the state. Two Utah residents returned from Disneyland with the disease, prompting an investigation by the Utah Department of Health. Two hundred and fifty-nine people were asked to be put on voluntary quarantine, which required daily check-ins by the Health Department to monitor symptoms and ensure compliance. Those in quarantine were required to stay in their homes and have no visitors who were not vaccinated.

Ultimately the mission to stem the outbreak took almost two months and cost the Health Department $115,000 to contain it. The outbreak was declared over on Feb. 25, 2015.

While measles outbreaks are still relatively rare in the United States, the World Health Organization’s data for 2014 showed that close to 115,000 children died from the disease that year. However, since beginning a campaign to increase measles vaccination availability in the year 2000, deaths from the disease have dropped by 79 percent, saving an estimated 17.1 million lives.

The Wakefield Effect

Eden said the Wakefield paper, despite being retracted, has been very damaging towards public perception of vaccines.

“I think it all started with the MMR-causes-autism false research that was debunked … that set us back a huge amount,” she said. “People have a hard time realizing that that study was not done correctly … it’s never been able to be replicated. In fact, all the research has proven otherwise.”

Despite the misconception of Wakefield’s report, Eden said, there is only a miniscule chance that a child will have an negative reaction to immunization, Eden said, while the outcomes for children who contract measles is far more concerning.

“One in a millions kids may possibly have an adverse reaction to an immunization,” Eden said. “Where one in two hundred children who get measles will actually die.”

Status of the bill

On Feb. 22, the proposed bill was given a favorable recommendation by the Health and Human Services Committee by a 7-3 vote with 2 not voting. It was returned to the House, where it is currently in its sixth substitute draft and on the third reading calendar, the final phase of the House’s consideration. If passed by the House, it will move to the Senate for consideration.

Read the text of the sixth substitute bill here: 2016 HB 221 6th Substitute – Immunization of Students Amendments


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