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UPDATE: S.199, passed out of the Senate Health and Welfare Committee 3-1-1 on Tuesday and will likely be taken up on the floor of the Senate later this week.

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Parents who don’t want their children to be vaccinated are fighting the elimination of a “philosophical exemption” that allows them to bypass Health Department vaccination requirements for children in school or daycare.

S.199, introduced by Sen. Kevin Mullin, R-Rutland, would only allow parents to decline vaccinations for diseases like measles and chicken pox if their decision is based on religious or medical grounds. Another bill introduced in the House by Rep. George Till, D-Jericho, who is a medical doctor, would do the same thing.

Children must receive vaccinations before entering kindergarten or child care facilities unless they decline a vaccine on philosophical grounds. For school, children must have six vaccines that cover 12 diseases; for child care, two additional vaccines are required.

The debate pits public health policy against tightly-held parental rights.

“It’s a real battle because you don’t want to take away from parental rights, but the public health has to be considered,” Mullin said.

Mullin said a national study prompted him to look into the issue when he learned Vermont did not rank well in vaccination rates compared to other states.

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Mullin acknowledges the inherent risks in vaccinating children for communicable diseases, but the benefits, he said, far outweigh the potential harms.

“When you look at data as far as lives saved, the benefits far exceed the risks,” he said.

Mullin said the Committee on Health and Welfare should vote on the Senate bill some time this week.

The Department of Health supports the bill.

Health Commissioner Dr. Harry Chen said he is concerned about Vermont’s dip in vaccination rates.

“Vermont is consistently one of the healthiest states,” Chen said. “One of the challenges we face is our mediocre vaccination rates.”

Sixty percent of Vermont children 19 to 35 months old are “adequately vaccinated” according to a 2009 Centers for Disease Control and Prevention survey. This means they received routine vaccinations for diseases like polio, measles and hepatitis B. In addition, the state has one of the highest rates of non-medical exemptions in the country, according to the Department of Health.

“The challenge is that these vaccines are so good that nobody knows what these diseases is,” Harry Chen said. “We’re seeing a product of our own success.”

Vermont is one of 20 states in the country that allows a philosophical exemption.

A rising rate of unvaccinated children, Chen said, could put others at risk. The more children who are not vaccinated the greater the potential for an outbreak of a disease like measles.

The concept is called “herd immunity,” and the basic idea is that the spread of disease will be disrupted if more members of the community are immune to a disease. Unvaccinated individuals are indirectly protected by vaccinated individuals because the latter will not transmit the disease to them even though they are susceptible to it. Hence, the more people who are not vaccinated, the more likely a pandemic is to break out.

While there have been measles outbreaks in Europe and Canada relatively recently, Chen said, “The challenge is that these vaccines are so good that nobody knows what these diseases is. We’re seeing a product of our own success.”

At the request of the committee, Chen offered a sort of middle ground where parents could retain the philosophical exemption as long as they make the decision based on a sort of informed consent with a health care provider.

The problem for some pediatricians, Chen said, is that they do not want the responsibility of taking on patients who decline immunizations because they worry about the safety of the child and possible contagion.

A recent article in the Wall Street Journal highlights the increasing rate of doctors “firing” patients who refuse vaccinations.

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Chen says the science behind vaccination safety is rock solid, and ensuring a high rate of vaccination is one of the most important things a government can do to protect public health.

He said vaccinations have prevented many illnesses in the past 30 years. In his personal practice, Chen said, 20 years ago he saw kids die who wouldn’t have today because of vaccines.

But for parents who champion the right to make the decision whether to vaccinate a child on their own, taking away the philosophical exemption cuts into their civil rights.

Furthermore, not everyone is so sure vaccinations are as safe as the government wants people to think.

Jennifer Stella, a member of the Vermont Coalition for Vaccine Choice, said the exemption is a safety as well as a personal choice issue.

“The exemption for parents is really a basic right to protect our kids.” ~ Jennifer Stella

“The exemption for parents is really a basic right to protect our kids,” she said. “It’s a basic duty and a right for us to help make medical decisions for our children.”

Stella is skeptical of the low vaccination rate for children in Vermont and its ramifications. While the state appears to have a low vaccination rate according to CDC statistics, looking to the vaccinations the state requires (as opposed to CDC recommendations), Vermont exceeds the federal recommendations, Stella said.

And she is not so sure vaccines are safe either.

The group cites the case of a 7-year-old Barton girl who died in December a few days after receiving a flu shot.

According to a CDC information statement, one in 1,250 children who had combined doses of measles, mumps, rubella and varicella (chicken pox) vaccine have had fevers and fever-related seizures.

Stella insists that parents who made the decision not to vaccinate their children are not irresponsible. Often they are highly educated and do extensive research.

Stella is a trained microbiologist, and she said she is frustrated by media coverage portraying parents who opt out of vaccines as a little loony.

She points to a 2011 study and law review article sponsored by Pace Law School that recommends further congressional and scientific study into the association between vaccine-induced brain injury and autism and the integrity of the no-fault federal system that compensates people for vaccine injury.

The debate over a discredited British study that showed a link between autism and vaccines continues as well, Stella said. She points to numerous studies that have repeated the work to some extent of the study by Andrew Wakefield, the doctor who performed the study.

The continued controversy over whether to require immunizations reached the federal level this year with the prominent HPV vaccine issue rising to the surface early in the Republican presidential primary. In particular, the medical community issued a quick criticism when candidate Michelle Bachmann made a statement to a reporter that the vaccine could cause mental retardation.

Recently, a cartoon appeared in the weekly newspaper Seven Days picturing a child in a coffin and making fun of the parents for rejecting a vaccine.

Mullin said he saw the cartoon as a cheap shot.

“People who don’t believe in vaccinations just don’t believe in it,” he said. “They’re not bad people.”

For some parents, like Gaelan Brown of Fayston, the philosophical exemption is really a civil liberties issue. Brown’s 7-year-old son has had some vaccinations, and he has used the philosophical exemption for others.

Brown said his son is one of the healthiest in his class. He said he depends on things like a healthy lifestyle help the child’s immune system.

Brown said he sees the campaign to push for more immunizations as scare tactics.

“They’re creating a false issue in an attempt to take away our civil rights and give them carte blanche in the future,” he said.

Regardless of the scientific merits of vaccinating more children, Cheryl Hanna, a constitutional law professor at Vermont Law School said the state may run into legal issues should it take away the philosophical exemption.

Hanna wrote a commentary for Vermont Public Radio last week on the legal ramifications of the law. She emphasized she is not taking sides, but noted that interesting constitutional issues do arise.

Most exemptions to laws that affect the general public are based on religious grounds, Hanna said. For example, the Amish argue their children should not have to go to school beyond age 14. The U.S. Supreme Court found that compulsory education after eighth grade violated their right to freedom of religion.

An interesting wrinkle in Vermont law, Hanna said, is the state takes a harder stance in its constitution on prohibiting the establishment of religion. For example, under federal constitutional law, parents can use state vouchers to pay for their children’s education at religious schools. In Vermont they cannot. So there could be an argument that taking away the philosophical exemption but leaving the religious one would violate the state constitution.

“As a legal matter, the state can probably do all or nothing,” she said. “It’s on solid footing doing what it’s currently doing or by taking away the religious and the philosophical exemption. It’s interesting whether under the state constitution it could take away the philosophical but not the religious.”

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