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Peter Hotez

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.

Ebola treatment progress

This is encouraging.

Texas scientists who developed an effective vaccine for the deadly Ebola virus are now reporting promising results with new medication to better treat full-blown cases of the disease.

In a laboratory study published this week, researchers at the University of Texas Medical Branch at Galveston showed a single injection of two antibodies successfully treated monkeys infected with all strains of the virus, a significant advance on current treatment options which only cover one strain and require multiple injections.

“This medication would give doctors an advantage in situations where we don’t know which strain of Ebola is going to pop up next,” said Thomas Geisbert, a UTMB professor of microbiology and immunology and the study’s primary investigator. “The fear now, with all our eggs in one basket, is we’ll get burned with the outbreak of a strain there’s no protection against.”

Geisbert said the study results, published Wednesday in Cell Host & Microbe, suggest the medication would be effective even if Ebola viruses evolve over time, and Larry Zeitlin, president of Mapp Biopharmaceutical Inc., the drug manufacturer, said it should “reduce the burden on health-care workers in the field during outbreaks.”

[…]

New medications are increasingly being used in the Congo to treat Ebola, most notably ZMapp, which was initially deployed late in the first outbreak. But those medications work only against the Zaire strain and require multiple injections, a challenge in Third World settings. ZMapp, for instance, must be given three times, each a few days apart, and by infusion which takes up to five hours. The single infusion of MBP134 only takes minutes.

“That’s a huge advantage in chaotic outbreaks or reactive settings where it’s often difficult to track down and identify patients to give them a second dose,” said Dr. Peter Hotez, founding dean of the National School of Tropical Medicine at Baylor College of Medicine and Texas Children’s Hospital.

Hotez added that “of course, all of this needs to be confirmed in human clinical trials.” He said the current outbreak in the Congo “looks like a good time for such an evaluation.”

See here and here for some background. I don’t have anything to add here, I just thought we could all use a bit of positive news.

Where the anti-vaxxers are

A lot of them are right here.

Four Texas cities, including Houston, rank among the 15 metropolitan “hotspots” of vaccine exemptions, more than any other state, according to a new study.

The study found Austin, Fort Worth and Plano also are among the nation’s cities with the highest number of kindergartners not getting vaccinated for non-medical reasons. Since 2009, the proportion of children opting out of such recommended vaccines increased in Texas and 11 other states, the study showed.

“There are some scary trends we were able to identify,” said Dr. Peter Hotez, a Houston vaccine scientist and one of the study authors. “They’re a sign that anti-vaccine groups, such as Texans for Vaccine Choice, have been very successful at lobbying efforts – both of the Texas legislature and through social media and other advocacy — to convince parents not to vaccinate their kids.”

[…]

The overall number of people invoking non-medical exemptions isn’t yet high enough to threaten herd immunity, the idea that vaccination of most of the population provides protection for those individuals without immunity to a contagious disease. But public health officials fear clusters of “anti-vaxxers” could leave some children vulnerable.

Texas’ increasing exemptions have been well documented. Though the number is still small, they have spiked from less than 3,000 in 2003 to more than 45,000 of the state’s roughly 5.5 million schoolchildren today, a 19-fold increase.

Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine and Texas Children’s Hospital said he undertook the study because of the Texas increase. He said wanted to look at whether it was a phenomenon unique to the state or mirrored elsewhere. National vaccination rates haven’t changed much in recent years.

You can see the study here. Dr. Hotez is correct to identify the political problem as being a key aspect to this. One clear pathway to getting more kids vaccinated is to take away or at least tighten up the so-called “conscience” objections to vaccines. If the law says you have to vaccinate your kids, the odds are pretty good that you will. But first you have to pass such a law, and right now we have a legislature that’s not inclined to do that.

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.