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The Immunization Partnership

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.