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There’s only one solution to the anti-vax crisis

They have to be beaten at the ballot box. There’s no other way.

On the South steps of the Texas Capitol, state Rep. Briscoe Cain prayed that the children standing beside him would not be mocked for their parents’ decision not to vaccinate them.

“We ask that you strengthen these children … we ask that you shield them,” said Cain, R-Deer Park. “May government leaders never forget that parents know what is best for their children.”

On Thursday, more than 300 anti-vaccination advocates and their children rallied with Texans for Vaccine Choice to support bills filed by a handful of state lawmakers that would require doctors to provide families with both the “benefits and risks of immunization,” and make it easier to opt out.

“I walk these halls and I see … the fun they are poking at our children and our families, and it angers me,” said the group’s president, Jackie Schlegel, who said her daughter is disabled due to complications from a vaccine. “The time is now to stand up, to be here for your families, to be here for your children, the ones who do not have a voice.”

Statewide data shows a steady rise in children whose parents have claimed conscientious exemptions from vaccine requirements. In 2018, 76,665 individuals requested affidavits for the exemption, an 18.8-percent increase over 2017, and a 63.8-percent increase since 2014, according to the Texas Department of State Health Services.

As the movement grows, Texas has seen a series of outbreaks of infectious diseases that were thought to have been virtually eliminated in the U.S.

You can see what we’re up against. Measles are back, someone was walking around the Capitol with whooping cough, idiots are deliberately exposing their own children to chicken pox, it goes on and on. Reason, civic duty, compassion for the immunocompromised, nothing moves these people. The one thing we can do is throw the legislators who coddle them out of office. Diminish their power, and the rest takes care of itself. So, just as a reminder:

Jonathan Stickland, HD92, won in 2018 by a 49.8% to 47.4% margin, in a district where Beto O’Rourke got 48.3% of the vote.

Matt Krause, HD93, won in 2018 by a 53.9% to 46.1% margin, in a district where Beto O’Rourke got 48.2% of the vote.

Bill Zedler, HD96, won in 2018 by a 50.8% to 47.2% margin, in a district where Beto O’Rourke got 49.5% of the vote.

I wish I could make a case for Briscoe Cain’s vulnerability, but alas, he’s in one of the two most Republican districts in Harris County. Still, take those three out and you’ve really weakened the anti-vax core. You want to see fewer kids get easily preventable diseases in Texas? There’s your starting point.

The anti-vaxxers keep on coming

Eternal vigilance, and some more problematic legislators getting booted out of office, are required.

Among the new Texas proposals is an “informed consent” bill filed by state Representative Bill Zedler, an outspoken anti-vaccine member of the House Public Health Committee. Zedler drew national attention after he downplayed the resurgence of measles, which he had as a child, telling the Observer last month, “Today, with antibiotics and that kind of stuff, they’re not dying [of measles] in America.” (Hundreds of Americans died of measles each year before the disease was considered eradicated in 2000, thanks in large part to the development of a vaccine. Also, antibiotics don’t treat measles, which is a virus.)

[…]

bill filed by state Senator Bob Hall, R-Edgewood, would ban vaccines that haven’t met criteria that Hall — a retired business owner — has determined the U.S. Food and Drug Administration should be using for approval. The bill also requires the state health department to post online a “disclosure of any known injuries or diseases caused by the vaccine” and that the vaccine be “evaluated for [its] potential to: cause cancer, mutate genes, affect fertility or cause infertility, and cause autism spectrum disorder.”< The bill is “dangerous” and a “misunderstanding of how science and clinical trials work,” Lakshmanan said. Any link to autism, first proposed in a now-retracted study, has been repeatedly debunked. “The insinuation of this legislation is that vaccines are not well-tested and not safe, which is erroneous, incorrect and misleading,” she said. Hall did not respond to a request for comment.

Also of top concern for immunization advocates are proposals to make it even easier to opt out of vaccine requirements, even as “conscience” exemptions have skyrocketed in Texas from about 2,300 in 2003 to nearly 53,000 in 2017. A bill filed by House Freedom Caucus member Jonathan Stickland, R-Bedford, would allow nurses to sign off on exemption forms rather than just doctors. Another, from state Representative Tony Tinderholt, would prohibit doctors from refusing to see patients who aren’t vaccinated. And one from caucus member Matt Krause would make it easier to submit vaccine exemptions, and prevent the state health department from tracking them. Health experts say this would prevent the state from preparing for potential disease outbreaks, as well as make it impossible for families of very young or immunocompromised kids to know which communities have low vaccination rates.

See here for some background. You can find all these bills and more by going to the Texas Legislature Online page and doing a word/phrase search for “immunization”. It’s not always easy to tell with the language in these bills, but SB1813 by Sen. Jose Rodriguez, which appears to loosen requirements for pharmacists to administer vaccinations, looks good. I don’t see anything positive relating to the so-called “conscience clause” exemption, which is what allows parents to enroll unvaxxed kids in school because they don’t want to get them immunized. I don’t think we’re there yet for something like this. The best we can do this session is most likely going to be not letting anything bad get passed. Then we need to follow it up by beating as many of these anti-vax schmoes at the ballot box as we can. Make note of those names, these are the targets of interest.

Can we turn the anti-vax tide in the Lege this session?

It sure would be nice, and this needs to be the primary goal.

In Texas, children are required to have certain sets of vaccinations before they can be enrolled in public school – including the vaccine for measles.

But parents who have “reasons of conscience” for not wanting their children to be vaccinated are allowed to opt out of vaccinations, a practice that experts say is forming a dangerous trend that helped fuel the most recent measles outbreak.

Statewide, there was only one confirmed case of measles in each of 2016 and 2017. In 2018, there were nine confirmed cases of measles, authorities say.

There are seven confirmed cases so far in 2019.

The legislature does not define what constitutes a “reason of conscience,” meaning that any parent, for any reason, can decide not to immunize their children against dangerous and sometimes deadly diseases.

Close to 57,000 children in Texas went to public schools unvaccinated in 2018 for non-medical reasons, according to Allison Winnike, president and CEO of The Immunization Partnership. She said those numbers are growing year-over-year since the non-medical, “reasons of conscience” exemption went into effect almost two decades ago.

Concerns about the rise in measles cases is the fulcrum for this. Anti-vaxxers had a good session in 2017, but their advantage is more partisan than non-partisan, and a couple of their leading advocates – Reps. Bill Zedler and Jonathan Stickland – both had close wins in 2018 and will be big targets in 2020, along with others in Tarrant County.

All this is good, but so far the only vaccine-related bill I could find of any value was SB 329 by Sen. Kel Seliger would require a biennial report on any outbreaks of vaccine-preventable diseases and the number of children without vaccines under the “reasons of conscience” law, but it doesn’t change the “reasons of conscience” law itself. That’s where we need to go, and we may as well get started on it this session. And we’d better not wait, because the anti-vaxxers are actively trying to make things worse.

A bill filed in the Texas Legislature this month by Representative Matt Krause, a member of the far-right House Freedom Caucus, would make it easier for parents to request vaccine exemptions. A similar version was left pending after a House Public Health Committee hearing in 2017, but Krause’s new bill would go further, explicitly preventing the state health department from tracking the number of exemptions. Even though the exemption data doesn’t include anything that could identify individual students and is only available at the school district level, Krause and Zedler point to fears among anti-vaxxers that they will be tracked and bullied. “We’ve seen instances in California, stuff like that, where they start hunting people down,” [anti-vax Rep. Bill] Zedler said.

Public health officials say the proposal would curb their ability to identify and stop disease outbreaks, and parents of immunocompromised kids would have even less information to decide where to send their children to school.

“This is the modus operandi for anti-vaxxers in Texas: to promote exemptions, obfuscate and minimize transparency,” said Peter Hotez, a leading vaccine scientist and dean for the National School for Tropical Medicine at Baylor Medical School. “To do this in the middle of a measles outbreak in Texas is especially unconscionable.”

[…]

Krause, who is also backed by Texans for Vaccine Choice, argues that his legislation merely streamlines the process for parents who will obtain the exemptions anyway. He dismissed the many concerns raised by medical professionals last session. “They did a very good job of painting the worst-case scenario,” Krause told the Observer. “I’m not so sure those fears are founded.”

Krause acknowledged that he has already fielded concerns about his bill, in particular the clause preventing the state from tracking vaccine exemptions. He said he would be willing to scrap that language “if Texans for Vaccine Choice or some other vaccine choice groups or other folks from the medical community say that’s a bad idea.” Texans for Vaccine Choice did not respond to a request for comment.

Rep. Krause’s bill is HB1490. He won by eight points in 2018, so be sure to find a good opponent for him too. As I’ve said many times before, the anti-vaxxers are better organized and far more vocal – Rep. Gene Wu notes his recent encounter with this bunch – but I continue to believe they’re a small minority. This needs to be an issue people lose election over, because the stakes are getting higher. Vox, Mother Jones, and Daily Kos have more.

Measles comes back to Houston

We all vaccinated our kids, right?

Five cases of measles have been confirmed in the greater Houston area, a regional cluster that makes Texas the eleventh state this year to report the highly contagious disease until recently thought virtually eliminated in the U.S.

The cases, all announced Monday, include three in Harris County, one in Galveston County and one in Montgomery County. They involve four children, all under 2 years of age, and a woman between the ages of 25 and 35. All are doing well now.

“This is a reminder for people to be on guard and be up to date on their vaccinations,” said Dr. Umair A. Shah, executive director for Harris County Public Health. “Measles, a serious disease, is in our community.”

Measles, caused by an airborne virus, is particularly dangerous, capable of causing serious neurological disorders and death in infants and the developing fetus in pregnant women. It is spread through direct contact with discharge through the nose and mouth as well as coughing and sneezing.

Shah said it was too early to say whether the five cases might be the start of a local outbreak. The counties are monitoring anyone exposed to the measles patients while they were contagious to see if they develop symptoms. None has so far.

Dr. Peter Hotez, an infectious disease specialist at Baylor College of Medicine and Texas Children’s Hospital, said he’s concerned because in the pre-vaccine era, measles typically peaked in the late winner and early spring. He said “a perfect storm could be coming.”

[…]

It was unclear Monday if a lack of vaccination played a role in any of the Houston-area cases. All four children had received the first of the two shots — the second is given between the ages of 4 and 6 — and the woman said she’d been vaccinated, though the county is still working to confirm that through records.

Shah noted that the first dose of the MMR (measles, mumps and rubella) vaccine is fully protective in 85 percent of those who get it, but there’s no way of knowing if a child is in that group or the 15 percent who need the second shot to receive full protection.

Shah also noted that the person or persons who originally transmitted the virus may have been unvaccinated, he said.

The good news is that this outbreak is limited. This story said that Houston’s vaccination rate is above the national average, while this other story says just the opposite; I’m not sure what to make of that. It’s still a lot of cases at one time, and we’re already close to the nine cases total in Houston from last year. It could be worse, as the people in the greater Portland area can attest, but there’s no reason at all why it should be. You can listen to a short but timely interview with Dr. Hotez about the resurgence of measles here, and Texas Monthly has more.

Still talking vaccines and measles

Because it keeps needing to be talked about.

Earlier this month, Dr. Peter J. Hotez, a pediatrician at Baylor College of Medicine and director of the Texas Children’s Hospital Center for Vaccine Development, detailed a disturbing prediction for 2017 in an op-ed for the New York Times: the country could be facing a measles outbreak, and the Lone Star State could among the earliest casualties. “Texas, where I live and work,” Hotez wrote, “may be the first state to once again experience serious measles outbreaks.”

[…]

The spread of measles—one of the most contagious and deadliest diseases—could be stopped by the Eighty-fifth Texas Legislature, where there are currently pending bills that take aim at correcting the anti-vaccination trend. In December, State Representative Donna Howard, a Democrat representing Austin, filed a bill that would require parents and students who choose not to be vaccinated to indicate that they will “opt-out,” as opposed to the current system in which people must “opt-in” in order to be vaccinated. The bill would also require education for parents and students before they choose to opt-out. A similar bill filed by Representative Sarah Davis, a Republican from Houston, would require parents to complete an online educational course to inform them about the dangers of opting out of vaccination.

But anti-vaxxers make up a strong political bloc, and they’ve successfully thwarted pro-vaccination efforts in the Lege before. In 2015, state Representative Jason Villalba of Dallas tried to pass a law that would have entirely removed the exemption protection for parents who claimed to have a “conscientious objection” to vaccinations. His proposal was promptly torn to pieces by a few thousand members of a Facebook group for Texas anti-vaxxers, which formed a PAC, Texans for Vaccine Choice, that ultimately killed Villalba’s bill.  “These people, they literally said it to my face—they hate me,” Villalba told the Texas Tribune in April 2016, after his bill flopped. “This is a group that is very dedicated, very organized; this issue is very important to them.” Even after the bill failed, the PAC kept on Villalba. Jackie Schlegel, the PAC’s creator, told KUT in January that PAC members “knocked on nearly 10,000 doors for his challenger.” Villalba narrowly avoided defeat. Villalba told KUT that he supports Representative Davis’s bill, but it seems unlikely he’ll try to revive his own. “I’m not interested in a suicide mission on this issue,” Villalba told the Tribune last April.

Texas remains one of only seventeen states that allow parents to exempt their children from receiving vaccinations due to philosophical objections. None of the currently pending bills in the Lege would change that. Still, the Texans for Vaccine Choice PAC has already started to push back against the pro-vaccine billse. The anti-vax crowd is active on social media, and let Davis know that they were upset about her bill. In several exchanges with these folks on Twitter in late January, Davis shot down claims that vaccines cause autism by calling such assertions “alternative facts.

See here and here for some background, then go read Rep. Davis’ Twitter battle with the anti-vaxxers. I’ve never been a big fan of hers, but my respect for her is higher than ever after seeing that. Despite the fact that the anti-vaxxers have a friend in the White House, I do believe we can get one or both of Rep. Davis and Rep. Howard’s bills passed. The anti-vaxxers are as we know an organized and vocal minority, but in the end they are still a minority. We do have them outnumbered, and we need to remember that. If you’ve gotten yourself in the habit of calling your legislators about this and that these days, please add these two bills to your list of things you ask them to support.

Trump and the anti-vaxxers

In case you needed another reason to dislike Donald Trump.

President Trump’s embrace of discredited theories linking vaccines to autism has energized the anti-vaccine movement. Once fringe, the movement is becoming more popular, raising doubts about basic childhood health care among politically and geographically diverse groups.

Public health experts warn that this growing movement is threatening one of the most successful medical innovations of modern times. Globally, vaccines prevent the deaths of about 2.5 million children every year, but deadly diseases such as measles and whooping cough still circulate in populations where enough people are unvaccinated.

Here in San Antonio, 80 miles southwest of the state capital, Texans for Vaccine Choice convened a happy hour to encourage attendees to get more involved politically. The event was among dozens of outreach events the group has hosted across the state. The relatively new group has boosted its profile, aided by a savvy social-media strategy, and now leads a contentious fight over vaccines that is gearing up in the current legislative session.

The battle comes at a time when increasing numbers of Texas parents are choosing not to immunize their children because of “personal beliefs.” Measles was eliminated in the United States more than 15 years ago, but the highly contagious disease has made a return in recent years, including in Texas, in part because of parents refusing to vaccinate their children. A 2013 outbreak in Texas infected 21 people, many of them unvaccinated children.

The modern anti-vaccine movement is based on a fraud. A study published almost 20 years ago purported to show a link between childhood vaccines and autism. The data was later found to be falsified, and the study was retracted.

[…]

Peter Hotez, director of the Texas Children’s Hospital Center for Vaccine Development, predicts that 2017 could be the year the anti-vaccination movement gains ascendancy in the United States. Texas could lead the way, he said, because some public schools are dangerously close to the threshold at which measles outbreaks can be expected. A third of students at some private schools are unvaccinated.

“We’re losing the battle,” Hotez said.

Although the anti-vaccine movement has been strong in other states, including California, Oregon, Washington and Colorado, experts say the effort in Texas is among the most organized and politically active.

“It’s a great example of an issue that has a targeted, small minority but an intense minority who are willing to mobilize and engage in direct action,” said Mark Jones, a political science professor at Rice University in Houston.

We’ve discussed this plenty of times before, and as you know I agree with Mark Jones. There’s no reasoning with these people. There’s only organizing, and making it so that being anti-vaccination – and let’s be clear, that’s what allowing broad parental-choice exemptions for vaccinating children is – is a disqualifier for public office. Either we vote these enablers out, or we suffer the consequences.

The coming measles outbreak

I hope we’re wrong about this.

Peter Hotez used to worry mostly about vaccines for children in far-away places. An infectious diseases researcher at Baylor College of Medicine in Houston, Texas, Hotez is developing shots against diseases in poorer countries such as hookworm and schistosomiasis.

But now, Hotez is anxious about children much closer to home. The number of schoolchildren not vaccinated against childhood diseases in Texas is growing rapidly, which means that the state may see its first measles outbreaks in the winter or spring of 2018, Hotez predicted in a recent article in PLOS Medicine. Disgraced antivaccine physician Andrew Wakefield has set up shop in the Texan capital, Austin, and a political action committee (PAC) is putting pressure on legislators facing a slew of vaccine-related bills.

“Texas is now the center of the antivaxxer movement,” Hotez says. “There is a big fight coming,” adds Anna Dragsbaek of The Immunization Partnership, a nonprofit organization in Houston that advocates for vaccinations.

Texas still has one of the highest vaccination rates for childhood diseases overall, 97.4%, according to the U.S. Centers for Disease Control and Prevention. But the number of children not vaccinated because of their parents’ “personal beliefs”—as opposed to medical reasons—has risen from 2300 in 2003, when such exemptions were introduced, to more than 44,000 so far this year, according to numbers prepared by The Immunization Partnership based on Texas Department of State Health Services data. The actual number may be much higher because an estimated 300,000 Texan children are schooled at home, says Susan Wootton, an infectious disease pediatrician at the University of Texas in Houston; though the law requires these kids to be immunized too, parents don’t need to submit proof of vaccination.

Measles is an extremely contagious pathogen and often the first one to spread when vaccination rates dip below about 95%. The risk of outbreaks is even greater because unvaccinated children aren’t randomly distributed. In Gaines county in western Texas, for instance, the exemption rate is already 4.8%, and at one school in Austin, it’s 40%. “I would describe Texas as sitting on a ticking time bomb,” Wootton says.

[…]

Meanwhile, a PAC named Texans for Vaccine Choice has sprung up after state Representative Jason Villalba, a Republican lawyer from Dallas, proposed scrapping nonmedical exemptions last year. (The Texas House of Representatives voted down the bill.) “While they do not have a whole lot of money, they have a lot of people that they can deploy to interfere in primary campaigns,” Dragsbaek says. “They made Villalba’s primary campaign very, very difficult.” Rebecca Hardy, director of state policies at Texans for Vaccine Choice, says the group is not trying to convince parents that vaccines are dangerous, but fighting for their right not to immunize their children. (It’s also helping them apply for exemptions.)

Though almost all U.S. states allow religious exemptions from vaccination, only 18 permit exemptions based on personal beliefs; with 27 million residents, Texas is the most populous one. Another hotbed of resistance to vaccines, California, stopped allowing “philosophical exemptions”—which covered religious and personal beliefs—this year, after a measles outbreak that sickened more than a hundred people. The change in legislation led some Californians opposing vaccines to move to Texas, Hotez says.

The Texas legislature is now pondering several bills that would help shore up vaccination. One would make it compulsory for parents to complete an online course before refusing vaccination; another would require them to discuss their decision with a doctor. The bill with the best chances may be one that would allow parents to know the immunization rates at their child’s school. “This does not infringe on anyone’s right to have an exemption, it simply allows parents who need to protect their children to have adequate information to do so,” Dragsbaek says. But Hardy says her PAC is opposed to even this bill: “If it’s truly about a parent’s right to know the health status of a campus, then why are we not proposing bills that would give the rates of HIV-positive kids on campus, or hepatitis B-positive kids?” she asks.

The problem, as I’ve noted before, is that the anti-vax forces are vocal and organized, which gives them a disproportionate amount of influence in the Lege. If you’re still mad about the November election (and you should be!) and you’re looking to Do Something to make our state a better place, organizing in favor of pro-vaccination candidates and officeholders, in all levels of government, would be a good way to channel that energy. Note this does not have to be strictly partisan – Rep. Villalba, who drew the wrath of the anti-vaxxers in 2015, is a Republican. But until there’s a countervailing force against the likes of Texans for Vaccine Choice, they’re going to gain all the ground. You can’t fight something with nothing, and the pro-vaccine forces have nothing right now.

We’re going to be fighting about vaccinations for a while

I wish it weren’t so, but it is.

Texas is one of 18 states that allow non-medical exemptions to the vaccines required for school attendance. California had a similar law allowing non-medical exemptions, until last year when it enacted a law that has one of the strictest requirements in the country after a 2014 outbreak of measles traced to the Disneyland theme park infected more than 100 people around the country.

Many of the parents opting out of the immunizations, which are widely recommended by doctors, say they fear a link between the vaccines and health problems such as autism. But studies that they cite have been widely debunked by public health officials.

“Year after year we’ve seen a steady increase in the number of students with a conscientious exemption from vaccination in Texas,” said Christine Mann, a spokeswoman for the Texas Department of State Health Services. “But overall, the numbers are small.”

Even though statewide levels of vaccinations remain high, at over 98 percent, what concerns public health officials are the growing clusters of geographic areas with high rates of unvaccinated children. Texas went from just 2,314 “conscientious exemptions” in 2003 to 44,716 this year, according to the Texas Department of State Health Services.

Some parents are pressing state officials to let them know how many of their children’s peers are unvaccinated. Jinny Suh, who has a 4-year-old son, is helping spearhead a petition drive asking legislators to change state law so that the number of school exemptions is public. Currently, exemption rates are available for individual private and charter schools, but only district-wide for public schools.

State Rep. César Blanco, a Democrat from El Paso, introduced a bill during the last legislative session that would have required schools to notify parents about vaccination rates at the school level, but the bill was stalled in committee.

“As a parent, there are lots of things that people get very passionate about,” Suh said, “but for some reason, in my experience, vaccinations remains an almost taboo topic besides a few passionate people.”

Yes, the anti-vaxxers are a minority, but they are a vocal and organized minority, which is a recipe for political success. Unfortunately, the end result of that political success is a growing public health problem, which is compounded by a lack of leadership in our state government. Honestly, what we need here is for an organized pushback against the anti-vaxxers, a pro-vaccine Moms Demand Action kind of thing. The main difference here isn’t that there is an anti-vaccination legislative faction that needs to be countered. I doubt there are that many legislators who are truly anti-vaccination, though there are a decent number who are in favor of “conscience” objections to some extent. It’s more that there isn’t a vocal and active pro-vaccination legislative force that can advance the cause and/or defend against attempts to weaken vaccination requirements. People who want to see more kids get vaccinated and fewer kids get exempted from vaccinations need to elect a few of their own. Until that happens, we’re going to see more stories like this one.

Too many kids are not getting vaccinated

We let this happen, thanks to the fervor of a vocal minority.

The number of Texans who exempt their children from vaccination for non-medical reasons rose nearly 9 percent last school year, continuing a now 12-year-long trend that public health officials worry could eventually leave communities vulnerable to outbreaks of preventable diseases.

The new numbers represent a 19-fold increase since 2003, the first year that Texas law allowed parents to decline state immunization requirements for “reasons of conscience.” The number of such exemptions are still small, a little under 45,000 of the state’s roughly 5.5 million schoolchildren, but they’ve spiked from less than 3,000 that first year, according to the new state data.

“The trend is going in the wrong direction,” said Anna C. Dragsbaek, president and CEO of The Immunization Partnership, a pro-vaccine group. “It’s time for the community to step up and take action on this very troubling trend.”

Concern has picked up in recent years amid the re-emergence of diseases such as measles and whooping cough. A large measles outbreak last year, linked to an initial exposure at Disneyland in California, sparked particular distress.

Texas is one of 18 states that allows waivers of school vaccine requirements based on parents’ conscience or personal beliefs. Only two states – Mississippi and West Virginia – don’t grant exemptions from immunization requirements on religious grounds, and all states allow exemptions for medical conditions, such as a compromised immune system.

[…]

Pushed by the Immunization Partnership, the 2015 Legislature considered a bill that would have required the Texas Department of State Health Services to post the exemption numbers of every school on its website.

Under the current law, the department is only required to post aggregate numbers for each school district.

The bill passed the House but died in the Senate. Dragsbaek, impressed at the traction the legislation got, said the partnership will push hard on behalf of any such bill again in 2017.

The bill to require school-specific information called for the inclusion of delinquency numbers, also a big problem. At HISD, for instance, more than 3 percent of children in 2015-2016 – who hadn’t obtained a conscientious exemption – had not received at least one of each vaccine by the district’s age-specified deadline. Enforcement of such deadlines is up to the principal.

“Eleven percent of HISD’s prekindergarten students hadn’t received their first dose of measles vaccine 90 days into the school year,” said Dr. Susan Wootton, a pediatrician at University of Texas Health Science Center at Houston who is leading an HISD task force on immunization delinquency. “That needs to be fixed. Nepal does better than that.”

Harris County’s overall conscientious exemption rate is still relatively low, just 0.62 percent, but it’s doubled in the last five years. So has Montgomery County’s, now 1.73 percent. Brazoria County has gone from 0.30 to 0.80. Gaines County in West Texas has the state’s highest conscientious exemption rate, nearly 5 percent.

That would be a worthwhile bill, but the real goal needs to be to eliminate the “personal belief” exemptions, which are an increasing threat to public health. Unfortunately, the pushback on that last session was ferocious, and that has emboldened the anti-vaxxers. I don’t know how much optimism I have about the school-specific information bill as a result. There are plenty of people who would like to see better vaccination laws, but the energy and organization is on the other side. It would help to get some leadership from, say, the Governor’s office, but he has none to offer, so the rest of us are on our own.

Anti-vaxxers gain ground in Texas

There’s a lesson in here that we need to learn.

On a Friday night little over a year ago, a Texas mother of three was attending a school dance when she got a text message that stopped her cold.

A state lawmaker from Dallas had filed legislation taking aim at a provision in state law that allows parents to opt their children out of school immunization requirements.

“I looked at that text and I just kind of was like, ‘Oh no he didn’t,’” said Jackie Schlegel-Polvado, who lives near Bastrop. “This is Texas. We believe in parental rights in Texas. Like, that is just a fundamental belief that most Texans have that parents make decisions for their children, not the state.”

It was an issue that directly affected Schlegel-Polvado and her family. Since 2007, she has been one of a small but growing number of parents in Texas who obtain “conscientious exemptions” from state vaccine requirements.

What was several worried parents exchanging text messages over the next few days turned into a Facebook group that within two weeks had more than 1,300 members, and then, ultimately, a political action committee.

Texans For Vaccine Choice’s mission, according to Schlegel-Polvado, is to guard parents’ rights to opt out of vaccine requirements — whether that means targeting legislators who seek to close non-medical exemptions or pushing for policies that otherwise protect parents who choose not to vaccinate, like preventing physicians from excluding them from their practices.

In this year’s primary elections, that meant going after state Rep. Jason Villalba, the Dallas Republican who filed the bill.

“The animus that was leveled against me for that was very surprising to me,” said Villalba, who ultimately won his race. “These people, they literally said it to my face — they hate me. That was troubling. Because I get it, they care about their children — but I care about my children too, and the children of the community.”

[…]

State law requires that children at all public and private schools have 10 different immunizations, including for tetanus, measles and pertussis, the bacterial disease known as whooping cough. Generally, children must receive those vaccines by the time they are in kindergarten, though they receive others, like for hepatitis B, in later grades.

If parents wish to opt out of school immunization requirements, they must file a what’s known as a “conscientious exemption” form with their child’s school at the start of the year. All but two states — West Virginia and Mississippi — grant exemptions from school immunization requirements on religious grounds. Texas is among 18 that also waive requirements because of personal beliefs, according to the National Conference of State Legislatures.

Under Villalba’s initial measure, Texas would have only allowed students to receive exemptions for medical reasons, such as an allergic reaction or in instances where a weakened immune system could cause health complications.

Pediatricians — many of whom have watched with dismay as the number of parents choosing not to vaccinate their children has climbed — widely support the elimination of non-medical exemptions to immunization requirements.

[…]

During the 2015 legislative session, Villalba said he quickly became acquainted with the passion of the anti-vaccine movement’s supporters, many of whom believe the undue influence of pharmaceutical companies has led to an overabundance of immunization requirements that come at the expense of children’s health.

“This is a group that is very dedicated, very organized; this issue is very important to them,” he said.

[…]

For now, the new organization’s strength appears to lie in its mobilizing abilities. A February campaign finance report showed just over $1,000 in contributions. And while its members made their presence felt in Villalba’s race, he still managed to win with 55 percent of the vote.

But Villalba said that without the engagement of the group, he would have expected his margin of victory to be larger.

It also may have accomplished a broader goal. The lawmaker said that for the 2017 legislative session, he does not plan to re-file his bill narrowing exemptions to the state’s vaccine requirements.

“I’m not interested in a suicide mission on this issue,” he said. “I sense — and this is unfortunate — the only way a bill like this gets any traction is an even worse large-scale outbreak, between now and session. Short of that I just don’t think there is going to be the appetite to do this bill.”

See here for some background. The lesson here is that intensity matters. A group of people that care passionately about a single issue and organizes around it can often get what they want in our political system, even if they’re a distinct minority. These anti-vaxxers are but one example; I’m sure you can think of many others. The number of unvaccinated children in Texas schools is still fairly small, less than one percent of the total, but it’s grown by more than ten times since 2004. This kind of idiocy is the reason why measles has made a big comeback in the US and around the world after being declared eradicated. I can’t blame Rep. Villalba, who was left hanging by Greg Abbott, for not wanting to deal with this crap next session. If the rest of us want someone else to pick up the ball on this, we’re going to need to make at least as much noise about it as these dangerous fanatics have done. Complaining about them is easy. Doing something about it is hard. It’s up to us.

How to deal with anti-vaxxers

It’s a big problem.

Certain that they are right, struggling to find ways to get their message across, public health officials are exasperated by their inability to convince more U.S. parents to vaccinate their children.

“I think we’re all kind of frustrated,” said Stephen Morse, a Columbia University infectious disease expert. “As scientists, we’re probably the least equipped to know how to do this.”

They say they are contending with a small minority of parents who are misinformed — or merely obstinate — about the risks of inoculations. The parents say they have done their own research and they believe the risks are greater than health authorities acknowledge; they are merely making their own medical choices, they say.

Most parents do bring their children for shots, and national vaccination rates for kindergarteners remain comfortably above 90 percent. Experts aren’t even sure the ranks of families who don’t vaccinate are growing to any significant degree.

But in some states, the number of parents seeking exemptions from school attendance vaccination requirements has been inching up. In some communities, large proportions of household skip or delay shots. The rise has come despite unsettling outbreaks of some vaccine-preventable diseases that had nearly disappeared from the United States.

“Part of the reason everyone is so concerned about this is because they don’t know whether things will get worse,” said Dr. Walter Orenstein of Emory University, considered one of the nation’s leading experts on vaccines.

[…]

Experts see the cooperation of physicians as a key to prodding families to get old and new vaccines. They believe too many family physicians and pediatricians have been lax. Some doctors perhaps see themselves as too busy to spend time debating the value of vaccines with resistant families. Some have complained about the cost and hassle of stocking the shots. A smaller contingent may have their own questions about vaccine, and indulge families that want to postpone or skip shots.

ACIP has been looking at the problem. So has another national panel — the National Vaccine Advisory Committee, chaired by Orenstein — which two years ago convened a Vaccine Confidence Working Group to study the issue. In a draft set of recommendations presented this month, the group said there’s not enough good information on where clusters of unvaccinated people are, to what extent they are growing, and why they exist.

The workgroup is recommending more study, and better training of physicians so that they will work harder to present childhood vaccination as the sensible way to go.

Another strategy is to simply make more parents vaccinate, through a concerted effort to eliminate philosophical exemptions to vaccinations or to make the exemption application process more demanding. Several experts interviewed believed reducing exemptions is the most practical approach, in a country where individual freedoms are sometimes celebrated at the expense of the communal good.

I’m on record as being in favor of severely limiting personal exemptions for vaccinations, and taking a punitive approach as needed to compel the obstinate holdouts to comply. If you want to call this a matter of freedom, I say it’s my freedom to live a healthy life that’s at stake. Be that as it may, it would be much better if people were more willing to comply on their own. Ruth Graham, writing in Slate, makes an important point about this.

“There is a history of paternalism in medicine,” said Jordynn Jack, an associate professor of English at the University of North Carolina at Chapel Hill whose 2014 book Autism and Gender explores how ideas about gender have affected debates about autism, including the vaccine controversy. “The language that’s used by the scientific community to communicate that vaccines are safe sometimes falls into that paternalistic model. ‘I’m telling you what’s right, and I’m telling you as a scientific authority,’ ” Jack said. “For some people that’s persuasive, but for others it’s not.” In her book, Jack dissects how contemporary mothers often think of themselves as “warriors” on behalf of their sick children, fighting first for a diagnosis and then for treatment. If procuring basic care for a sick child feels like a battle, then why trust the enemy’s propaganda?

Concern about not being taken seriously by medical professionals causes other problems for women as well. Surely by now we have learned that a successful outreach program depends on being able to speak to people in a way they will relate to. Seems to me that’s a good place to begin here as well. Of course, as this AusChron post points out, people have to be willing to listen, and to understand what they’re being told, too.

Abbott waffles on vaccinations

Come on, dude.

Weighing in on a national debate, Texas Gov. Greg Abbott made clear this week that he supports laws that include exemptions to requirements that parents vaccinate their children.

“Abbott recognizes the public health benefits of vaccines and encourages all parents to have their children vaccinated, as he and the First Lady did with their daughter,” spokeswoman Amelia Chasse said, but the governor “supports current Texas law that he believes strikes the right balance of requiring vaccinations while still allowing parents to opt out under certain circumstances.”

That law gives parents the right to opt out if they have religious or personal objections to vaccines, or if they can cite valid medical reasons.

The governor’s position pits him opposite a high-profile suggestion that Texas eliminate the religious and personal exemptions in response to several recent outbreaks of measles.

I’m sorry, but that’s a load of bull. Unless you’re a Christian Scientist, your right to endanger yourself and/or your kids ends where my and my kids’ immune systems begin. There’s no longstanding tradition here, and no reason to needlessly put children’s health at risk. Go talk to Rep. Villalba, Governor. This isn’t about ideology, and it isn’t about “freedom”. There’s a right answer and a wrong answer here. Don’t screw it up.

Improving infections disease response

This is an Ebola-inspired bill, but not an Ebola bill. So say the stakeholders, anyway.

Months after three people in Texas were diagnosed with Ebola, several key state lawmakers on Wednesday proposed ways to prepare the state for the next disease-related emergency.

The proposal, Senate Bill 538, would allow the governor to declare a state of infectious disease emergency, create stockpiles of protective equipment, and grant health officials greater power to stop public transportation vehicles and detain individuals who may be infected.

“We’d have a clear line of authority,” state Sen. Charles Schwertner, R-Georgetown, chairman of the Senate Health and Human Services Committee, said at a Capitol press conference. “There would be stockpiles of personal protective equipment. First responders would be able to know when they were going to have to be around individuals with potentially infectious disease, a deadly infectious disease.”

The legislation stems from recommendations by a task force established by then-Gov. Rick Perry in October after a man in Dallas became the first person in the United States diagnosed with Ebola. The bill is designed to fix problems — highlighted by the Ebola scare — with the state’s ability to respond to an outbreak.

“This bill, although based on the Ebola emergency, is not an Ebola bill,” said Dr. Brett Giroir, director of the Texas Task Force on Infectious Disease Preparedness and Response. “This is preparation for any infectious disease emergency in the future.”

[…]

Based on the task force’s recommendations, two Ebola treatment facilities were established in Galveston and North Texas in October. A more detailed report released in December by the task force recommended establishing a treatment facility for children, training health workers to identify new diseases and expanding state executive power in disease-related emergencies.

“This emergency highlighted needs for profound changes in our training, in our preparedness, our protocols,” said Giroir, who is also CEO of the Texas A&M Health Science Center.

The bill would implement several of those changes, including new authority to quarantine infected people.

Under current law, the head of the Department of State Health Services can order a potentially exposed or infectious person to remain in his or her home, Giroir said. But the state cannot enforce that order until after the person has already broken the order and left the home, a redundancy that the new bill would eliminate.

See here and here for some background. I’m okay with this. I agree with Dr. Giroir that this is unlikely to be an “Ebola bill” in the sense that there are other infectious diseases that are much more likely to need containment in Texas. Measles, for example. We’ve got another bill that would help with that, and I hope it gets at least as much attention as this one does.

Ending exemptions for vaccines

Hear, hear.

A Texas Republican is taking aim at a provision in state law that allows parents with personal or religious objections to vaccines to opt their children out of school immunization requirements.

State Rep. Jason Villalba, R-Dallas, said Friday he will soon propose legislation to eliminate what are called “conscientious exemptions” because of the reemergence of diseases like measles and whooping cough attributed to growing numbers of parents choosing not to vaccinate their children.

“We are just saying, ‘Look, if you are going to send your children to public schools, they need to be vaccinated,'” he said. “We are going to ask that you keep other children safe.”

The measure, which Villalba said he would file next week, comes as several other states are reevaluating their immunization laws as they battle a measles outbreak linked with exposure to an unvaccinated woman in a California amusement park.

Texas is among 20 states that waive school vaccine requirements because of personal beliefs, according to the National Conference of State Legislatures. All but two states — Mississippi and West Virginia — grant exemptions from school immunization requirements on religious grounds.

Under Villalba’s proposal, Texas would not allow an exemption for either of those reasons. Students would still be able to receive medical waivers, which doctors grant in cases where an allergic reaction or a weakened immune system could cause health complications.

As you know, I’m down with this. Texas’ overall rate of getting exemptions isn’t that high, but in some places it is. That’s an outbreak waiting to happen, so I hope the rest of the Lege falls in behind Rep. Villalba’s bill when it is filed. On that score, the Senate may be a challenge.

Even with a measles outbreak dominating headlines, don’t expect an avalanche of immediate support for a high-profile idea to cut down on the ability of Texas parents to opt their children out of school immunization requirements.

Two state Senate committee chairmen told the Houston Chronicle they have hesitations about a bill that state Rep. Jason Villalba said Friday he plans to introduce to eliminate religious and philosophical exemptions to the requirements.

State Sen. Charles Schwertner, R-Georgetown, who leads the Health and Human Services Committee, said through a spokesman that while he views vaccines as a “critical component of protecting the public health…(he) would prefer to increase education about the safety of these vaccines rather than imposing new mandates that would ask Texas parents to act against their own conscience or their deeply-held religious beliefs.”

The chairman of the Senate education committee, Republican Larry Taylor of Friendswood, offered a more moderate response but noted that in Texas, “there is also a long standing tradition of giving parents the right to make decisions regarding their children’s healthcare.”

“I stand ready to hear parents’ and legislators’ opinions on this very serious issue,” Taylor said.

I hope he’s also ready to hear doctors’ opinions, too. California’s legislature is taking similar action, as are legislatures in several other states. Hopefully, at least one good thing will come out of the Disneyland measles epidemic of 2015.

Measles

We haven’t had an outbreak in Texas. Yet.

Measles has replaced Ebola as the infectious disease threat of the moment, but the only recent case in Texas occurred in Fort Worth in mid-January and was unrelated to the current outbreak that originated in Disneyland.

The Houston health department has tested two suspected cases and both came back negative, but local officials still express concern about the possible risk to infant children who can’t yet be immunized.

“Parents should be alarmed about this outbreak if they have children under 12 months,” said Kathy Barton, spokeswoman for the Houston health and human services department. “Infants travel to other areas, and the measles virus can be imported to any area at any time, including this one.”

Barton said parents of children who have been immunized should feel confident the vaccine will protect their child.

Children are eligible for the first dose of the combination MMR (measles, mumps, and rubella) vaccine at 12 months through 15 months of age. The second dose, recommended at 4 to 6 years of age, is required of Texas schoolchildren, though conscientious objectors can opt out by signing an affidavit. Those numbers in Texas are small (38,197 people, or 0.75%, in 2013-2014) but growing.

[…]

The national rate of people opting out of vaccination remains under 1 percent, but the number can vary according to community. In Texas, where the percentages have grown significantly in the last decade, the 2013-2014 rate exceeds 3 percent in five counties — Jeff Davis (3.1), Blanco (3.6), Robertson (4.1), Gaines (4.3) and Lampasas (5.2). Harris County’s rate is 0.57, up from 0.19 in 2007. The state’s county-by-county numbers are here.

Tiffany recently underwent a round of booster shots in anticipation of some business travel. I’ve been thinking of doing the same thing for myself. I don’t feel like herd immunity is good enough to rely on any more.

Cherise Rohr-Allegrini reminds us that however enjoyable it is to publicly shame anti-vaxxers, it doesn’t do much to actually get them to vaccinate their kids. Research has shown that no persuasion strategy for overcoming anti-vaxx sentiment is likely to succeed. As such, I personally agree with Jamelle Bouie that where persuasion fails, coercion is the way to go. There’s a reason Mississippi – Mississippi, for crying out loud! – has the best vaccination rate in the country: They don’t allow exemptions. Vaccinate your kids or they don’t get to go to school. In Texas, that would likely mean more home-schooling, so the next level of this strategy is to require vaccinations for participation in any kind of interscholastic activity, from sports to debate to music to whatever else. If it involves other school-age kids, you have to have your shots. Finally, I’d take aim at the one thing that will make all those highly-privileged anti-vaxxers from California squirm, and that’s to put pressure on colleges and universities to require vaccinations as a condition of entry, just as kindergartens used to do before anyone heard of “conscientious objections”. This can be accomplished by the Legislature for public schools. For private schools, it’ll likely take a campaign from alumni organizations. If their kids can’t get into Harvard without having had their shots, they’ll get their shots. Lisa Falkenberg and Harold Pollack have more.

Measles

Something we haven’t seen around here in awhile.

The Houston Area Health Alert Network sent an e-mail on Friday noting that an 11-month-old child, who attended the Cirque du Soleil performance at Sam Houston Race Park on March 20, developed fever the next day and a rash three days later. She later tested positive for the highly contagious virus.

The e-mail asked local health care providers to consider measles in patients presenting with a rash.

The baby is recovering, according to Kathy Barton, spokeswoman for the Houston health department.

Barton said health officials are aggressively investigating any contact the child may have had with at-risk people, but said the situation is nothing like it was in the late 1980s and early 1990s, when the city’s low child immunization rate — 11 percent — led to an outbreak that hospitalized one-third of confirmed cases.

Houston’s immunization rate is now 87 percent.

This was the first confirmed case since 2005. I think what caught my attention in this story is the unbelievably pathetic 11 percent child immunization rate from 20-25 years ago. How was it even possible to have been that bad not that long ago? That we’ve come that far since then is impressive, but I just can’t get over how far down we once were. I wish I could say we’ll never be there again, but with the brutal House budget decimating health and human services as it does, I’m not sure I can.