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Sen. Lauren Book (D-Plantation) has filed a bill (SB 64) for consideration by the 2020 Florida Legislature which includes elimination of the state’s religious exemption to K-12 school-entry immunization requirements. That portion of the bill, the focus of this post, would make Florida the sixth state (along with Mississippi, West Virginia, California, New York, and Maine) to allow only medical exemptions. In 2019, legislators in seven states introduced bills to remove religious or personal belief exemptions but were successful in only two: New York and Maine. SB 64 also eliminates the religious exemption to school health exam requirements and directs the Florida Boards of Medicine and Osteopathic Medicine to create a panel to review all medical exemptions to school vaccinations.

Sen. Book filed the bill after a Tampa Bay Times report that religious exemptions in Florida have risen from about 6,500 in 2011 to about 25,000 in 2018, a 375% increase in less than a decade. Sen. Book is concerned, according to her spokesperson, for public health and tourism (the state’s top industry), as well as the fiscal impact of measles outbreaks like those experienced in New York and California. According to the Florida Department of Health, 25 of the state’s 67 counties failed to meet the Department’s goal of 95% vaccination among kindergarten students in 2018. Almost 3% of kindergartners received a religious exemption, an all-time high. Stats improve at the seventh grade mark, with 61 counties meeting or topping the 95% goal. Medical exemptions have remained stable.

University of Florida medical ethicist Bill Allen told the Tampa Bay Times that the religious exemption is not being used for its intended purpose and is being abused.

‘If parents don’t want to vaccinate because they think vaccines cause Autism, they’ll claim a religious exemption,’ he said.

University of South Florida Health assistant professor Jill Roberts added that parents are claiming the exemptions after being persuaded by sophisticated online anti-vaccination misinformation groups. According to the report,

Those groups, with official-sounding names like the National Vaccine Information Center, propagate conspiracies like the debunked link between vaccinations and autism.

It is gratifying to see the media call out the NVIC for what it is.

The personal finances website WalletHub recently attempted to quantify how good the states are at vaccination by examining the 50 states and D.C. “across 18 key categories” ranging “from share of vaccinated children to share of people without health insurance to presence of reported measles outbreaks.” Florida came in 49th overall, hitting near rock bottom on several metrics:

Lowest influenza vaccination rate in children aged 6 months to 17 years old: ranked 50th

Lowest share of adults with tetanus vaccination: 49 th

Lowest share of adults aged 60 and over with zoster vaccination: 47 th (tied with Tennessee)

(tied with Tennessee) Highest share of civilian non-institutionalized population without health insurance coverage: 48th (tied with Oklahoma)

WalletHub’s stats on the benefits of vaccination are worth repeating here:

The World Health Organization (WHO) estimates that vaccines prevented at least 10 million deaths worldwide just between the years of 2010 and 2015. A similar study by the Centers for Disease Control and Prevention (CDC) found vaccines prevented 732,000 deaths in the U.S. between 1994 and 2013, as well as eliminated $1.38 trillion in total societal costs that those diseases would have caused. Vaccines are also very safe, and according to the WHO, ‘so few deaths can plausibly be attributed to vaccines that it is hard to assess the risk statistically.’

It is very, very easy to get a religious exemption in Florida and Kehoe Family Chiropractic of New Port Richey, Florida, is happy to tell you how. Their surprisingly comprehensive guide covers not only religious exemptions to vaccinations required for K-12 students but also how to take your children out of the state’s immunization registry. As well, it advises parents on how to get out of vaccinating their children in day care, college students on how to get out of recommended vaccinations for meningococcal meningitis and hepatitis B and required measles and rubella vaccinations, employees on how to get out of employer-required vaccinations (including the hepatitis B vaccine for those handling blood-borne pathogens), and everyone on how to avoid vaccination during public health emergencies. They perform this valuable service because, in their view, “all vaccines are made in violation of God’s word” even though vaccination is outside the chiropractic scope of practice in Florida and chiropractors are, in fact, prohibited from treating several vaccine-preventable infectious diseases (including hepatitis) by state law. The good chiropractors at Kehoe, in the tradition of anti-vaccination chiropractors everywhere, are perfectly willing to spout anti-vaxx talking points widely discredited by medical authorities as part of their advice, while at the same time telling parents that their infants and children should be checked for phantom subluxations and falsely claiming these can have a deleterious effect on their children’s health. They also regularly take full-spine X-rays of their patients to detect these non-existent subluxations and sell dietary supplements. But heaven forbid that your children be subjected to an immunization that, with an infinitesimally low risk of harm, can save their lives.

In any event, to claim a religious exemption to the K-12 public or private school vaccination requirements, all the parent or guardian must do is fill out the Department of Health’s Religious Exemption from Immunization Form (DH 681 Form), issued by county health departments for

a child who is not immunized because of his/her family’s religious tenets or practices. . . This form must be issued upon request. No other information should be solicited from the parent or guardian.

The form simply states that

I am the parent or legal guardian of the above-named child. Immunizations are in conflict with my religious tenets or practices. Therefore, I request that my child be enrolled in school [or other facility, such as day care] without immunizations required [by state law].

Only the child’s name, date of birth, and the parent or guardian’s name are required. The form is kept on file by the school (or other facility) so that unimmunized children can be identified and excluded from school during the outbreak of a vaccine-preventable disease, as is authorized by state law.

While there is no First Amendment right to refuse vaccination for one’s child based on religious belief, the state of Florida has nevertheless granted one by statute, and one Florida appellate court (although not the Florida Supreme Court) ruled, in 1998, that the law does not give the state any authority to inquire into a parent’s religious belief:

The issue which we are called upon to decide implicates two very important social policies-the desire to protect the public health and welfare and the desire to protect a parent’s fundamental right to raise his or her child according to the religious tenets that he or she chooses. After considerable reflection, we conclude that the legislature intended that when, as here, the two policies collide, greater protection be afforded to the latter by prohibiting any inquiry by the Department into the bona fides of the parent’s or guardian’s objection.

Thus, although Florida does not recognize a philosophical exemption to vaccination, the religious exemption has essentially become one. This is fortunate for parents wanting to claim bogus religious objections, as none of the major world religions forbid vaccination and further inquiry might reveal their mendacity.

On the other hand, it puts parents who object to only some vaccinations in a bit of a bind. Because the religious exemption is a blanket one, parents claiming the exemption can appear insincere in their “religious” objections if they allow some, but not other, vaccinations although, again, further inquiry would be prohibited, at least by the state. And, if there were an outbreak, the exemption on file would presumably allow exclusion from school, even if the child had, in fact, been immunized against the disease causing the outbreak, at least until the parent could provide proof of immunization, with the attendant appearance of duplicity that would involve.

Interestingly, although the religious exemption applies to both public and private schools, the same appellate court, in 2017, citing the ecclesiastical abstention doctrine, refused to intervene in a dispute between a parent claiming the religious exemption for his child and the Catholic Diocese of St. Augustine, Florida, which required immunization for all students enrolled in its schools. Somewhat ironically, this means that schools run by religious organizations can ignore the religious exemption, at least in this appellate court’s jurisdiction.

The anti-vaccination crowd strikes

For her concerns about the health of Florida’s children, Sen. Book has been viciously attacked on social media, including a posting on her Facebook page of a doctored photo showing Sen. Book, who is Jewish, with a Hitler mustache and wearing a Nazi uniform. Of course, she is also accused of being in Big Pharma’s pocket.

Unsurprisingly, the anti-vaccine crowd has come out in force, attending local events with legislators to oppose the bill even when it wasn’t on the agenda. According to one media report,

Anti-vaccine groups Robert F. Kennedy Jr.’s Children’s Health Defense, the National Vaccine Information Center, Florida Health Action Network and the Florida Freedom Alliance orchestrated social media opposition and spurred large anti-vaccination turn-outs at public discussions on the bill in Broward, Manatee and Escambia counties.

Again, I’m pleased to see that these were correctly identified as “anti-vaccine groups”.

There’s even a website devoted exclusively to opposing SB 64, although it appears the site’s creators don’t want the public to know who’s responsible for its content, as they’ve chosen Domains by Proxy to register the website. There is no information on the website about its owners, authors, or funding sources. An educated guess points to two anti-vaccine organizations for funding: The World Mercury Project, headed by Robert F. Kennedy, Jr., and Stop Mandatory Vaccination. According to an investigation recently published in the journal Vaccine and reported in the Washington Post :

The majority of Facebook advertisements spreading misinformation about vaccines were funded by two anti-vaccine groups, including one led by Robert F. Kennedy Jr., according to a study published this week. The World Mercury Project, headed by Kennedy, and a California-based organization called Stop Mandatory Vaccination bought 54 percent of the anti-vaccine ads on Facebook, the study found. Researchers said the results surprised them. Much of the anti-vaccine content posted on social media platforms such as Facebook and Twitter may appear to be organic, grass-roots discussions led by neighborhood groups and concerned parents, said David A. Broniatowski, an associate professor at George Washington University and one of the authors of the study. ‘In fact,’ said Broniatowski, who studies group decision-making, ‘what we are seeing is a small number of motivated interests that are trying to disseminate a lot of harmful content.’ The small group of anti-vaccine ad buyers successfully used the ads to reach targeted audiences.

I won’t attempt to catalog, or refute, the firehose of misinformation being spread by the anti-vaccination cabal in opposing SB 64. (The lies and half-truths of the anti-vaccinationists have been covered many times on this blog, as well as by our good friend Orac and by others.) Unfortunately, their campaign has been somewhat successful. According to a spokesperson for Senate Health Policy Chair Sen. Gayle Harris (R-Stuart), the bill won’t get a committee hearing “in its current format”, but that does not exclude an amended bill or a newly submitted proposal. Another obstacle is that no companion bill has yet been filed in the House of Representatives, as is required by Florida law. (The deadline for filing a bill is Jan. 14, 2020.) And, as one news reporter pointed out, the Republican-led Legislature has an easy out by simply categorizing SB 64 “as a blow to religious freedom and parental choice, potentially dooming it even without the organized campaign that has been mounted in opposition”.

Sen. Book remains undeterred:

it’s worthwhile, substantive legislation and I will not be withdrawing it. . . We need to be discussing this issue . . . Researchers warn Miami-Dade is in the top three most vulnerable to an outbreak like those in New York and California – and Broward [Ft. Lauderdale] and Hillsborough [Tampa area] (counties) are in the top 15 most vulnerable.

I admire Sen. Book for her willingness to stand up to the well-financed, vicious, misinformation-spreading, public-health-menacing anti-vaccine lobby. Even if SB 64 fails, she has succeeded in making at least some legislators go on record as being against the bill and therefore holding them responsible when the anticipated outbreaks of disease occur.