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The Immunization Partnership

Measles, schmeasles

Eh, no biggie.

With U.S. measles cases this year reaching historic levels since being practically eradicated nearly 20 years ago, a host of bills targeting vaccination policies in Texas don’t appear to be gaining traction in the Legislature.

The U.S. Centers for Disease Control and Prevention has confirmed 704 cases of the measles in 22 states so far this year, the most of any year since 1994. Fifteen of those cases have been in Texas, the Texas Department of State Health Services said.

Considering the scope of the crisis, Rekha Lakshmanan, policy director for the Immunization Partnership, a group devoted to eradicating vaccine-preventable diseases, said lawmakers this session are missing an important opportunity to pass what she called “common-sense immunization laws,” among them bills aimed at increasing data transparency.

Notable among those measures are Senate Bill 329, filed by Sen. Kel Seliger, R-Amarillo, which would require the Department of State Health Services to publish the immunization opt-out rates for individual public schools. Currently, the health department is only required to post this information for districts as a whole and private schools. Another, House Bill 1966 by Rep. Gene Wu, D-Houston, would empower child care facilities to list their immunization opt-out rates for parents who are interested.

Vaccine advocates say making this data available would help parents choose the best place to send their children, particularly if the children have compromised immune systems and can’t be vaccinated.

“If you cannot vaccinate your child, then you need to place them in a child care facility with children who are vaccinated, I think, for the obvious reason that you know those children would not spread it to your child if there is a contagion that goes through the population,” Wu said of his legislation.

Opponents say the information does not reflect the overall health of a facility and could lead to kids being discriminated against for not being vaccinated, even though names would not be published.

Lawmakers heard testimony on both bills in committee hearings last week but did not vote on either. Next week is the deadline for the House to advance bills. The Senate has until May 22.

See here, here, and here for some background. This story was from the weekend, so please note that the House deadline for voting out bills is tonight at midnight. After that, it’s Senate bills or attaching amendments if your bill died in committee. The anti-vaxxers complaints do not move me. I see this as a matter of giving parents the information they need to make good choices. If that means that preschools and child care facilities are less inclined to take kids whose parents chose not to vaccinate them because it’s bad for their business, well, that should tell you something.

Also, too:

Amid a record-breaking national outbreak of measles, the number of Texans who exempt their children from vaccination for non-medical reasons took another big leap this past school year.

The number increased 14 percent in 2018-2019, continuing a 15-year-long trend that public health officials worry is leaving communities vulnerable to the resurgence of preventable diseases such as measles, which has been confirmed this year in 23 states, including Texas. The number of measles cases this year is the largest since 1994.

“Seeing non-medical exemptions increase again on a double-digit scale should create outrage for everyone,” Allison Winnike, president and CEO of the Houston-based Immunization Partnership, said in a statement. “It’s time for Texans to take action.”

Porfirio Villarreal, public information officer for the Houston health department, added that it’s “disappointing to see yet another rise in the number of parents opting out of life-saving vaccines, mostly due to the vast amount of misinformation on the internet and social media channels.”

The number of exemptions are still small, 64,176, but they represent a roughly 2,000 percent increase since 2003, when the state began allowing parents to decline immunization requirements for reasons of conscience. There were about 3,000 in 2003-2004, and a little under 57,000 in 2017-2018.

[…]

Texas is one of 17 states that allow waivers of school vaccine requirements based on parents’ conscience or personal beliefs. Only three states — California, Mississippi and West Virginia — don’t grant exemptions on religious grants. All 50 states allow exemptions for medical conditions, such as a compromised immune system.

Of course, tightening up the rules for exemptions is not on the table at all. The report that produced this data breaks it down by school district but – as we know – not by individual school. I don’t even know what else to say.

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.

Making vaccination information public

I support this.

While most parents in Texas vaccinate their children, the number of parents opting out of immunizations for non-medical reasons is on the rise. Since Texas changed its laws to allow parents to opt out citing a conscientious objection, the number of unvaccinated children has shot up more than 1,700 percent in 13 years, to 45,000 from 2,300. In response, parents and health advocates are backing an effort to increase public reporting on how many students who have skipped vaccines attend each school.

Currently, that data is housed at the state level and available via an open-records request. County and school district-level data also is available online.

House Bill 2249 would require the Texas Department of State Health Services to publish school-by-school data that would indicate the total number of students who forgo vaccinations, including those who opt out by choice, such as a religious objection. No names or identifying information would be listed.

Advocates for publishing the data say the information would offer parents insight into their child’s school and help them weigh whether to switch, particularly for parents of medically fragile children like Riki Graves’ daughter, Juliana. Now 3, she received a new heart at 18 days old, and doctors say she will need to attend a school where least 95 percent of the students are immunized.

“My job as a transplant mom is to protect that organ,” said Graves as she drove from her home in Sugar Land to Austin where she plans to testify before the House Public Health Committee on Tuesday. “We have the data … there’s no reason not to publish it.”

Opponents say there are plenty of reasons, including children’s medical privacy.

“If this is truly about keeping children safe, we have to have that honest conversation about keeping all people safe. It puts a target on the backs of children whose parents have chosen to opt out for various different reasons,” said Jackie Schlegel, a mother of three and executive director of Texans for Vaccine Choice, a grass-roots parent group that has ballooned in recent years as the movement against vaccinating children has gained traction. The group is planning a rally at the Capitol on Thursday, dubbed the “freedom fight.”

“At schools where you do have a high number of opt-out, we are creating a witch hunt against families, and that’s just unacceptable,” Schlegel said.

We clearly have a different definition of “unacceptable”. I think knowing that a given school has a high rate of unvaccinated children is something any parent would want to know. HB 2249 has four co-authors, two of whom )JD Sheffield and John Zerwas) are medical doctors, which ought to tell you something. As the story notes, an identical bill passed the House in 2015 but never got a hearing in the Senate. Let’s hope this year’s version meets a better fate. The Trib has more.

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.

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.