After three siblings were diagnosed with measles at Children’s Hospital Colorado in December, public health officials began tracking down 258 other patients who visited the emergency department that day and were potentially exposed to the disease.

Public health workers needed to find the children who came to the hospital that Saturday night, the parents and grandparents who brought them, and the siblings who tagged along. Authorities from multiple public health departments investigated the immunization history of the 258 people, called their homes and offered vaccines or intravenous antibody therapy, or asked them to quarantine themselves for three weeks.

It took most of a week, an estimated 3,600 hours of staff time and about $300,000.

The coordinated effort to make sure no one else contracted measles was described to state lawmakers Wednesday during an into-the-night hearing on a bill aimed at improving Colorado’s lowest-in-the-nation immunization rates. Health authorities on the case — which was isolated to three siblings who traveled internationally and were not vaccinated against measles — consulted a statewide immunization registry, a confidential database that keeps track of children’s vaccines from birth.

The story, from Tri-County Health Department’s Dr. Bernadette Albanese, helped illustrate the key point of the legislation’s supporters: Colorado needs to encourage more people to get their children vaccinated, and the state needs a more complete database of immunizations if there is an outbreak.

The measure has bipartisan support but is highly controversial. For hours, hundreds of parents, doctors and health advocates gave passionate testimony on both sides. For opponents, who were at the Capitol in force, the legislation is an invasion of privacy and a “government tracking system” that could result in parents pulling their kids from public school in favor of home-school.

It passed its first hearing on a 3-2 party line vote after 15 hours of testimony, at about 1:30 a.m.

Maddox and Lillian Eveland wait with their mom Tara Eveland, of Arvada, to testify against a bill about school immunizations, which was discussed in the Senate Health and Human Services Committee on Feb. 19, 2020. (Moe Clark, The Colorado Sun)

Here is what Senate Bill 163 would do:

— Under current law, parents who want to exempt their children from immunizations can write on a sticky note or even a napkin and hand it to their school office. This bill calls for a standardized form — the same form for medical, religious or personal exemptions — that parents would have to get signed by a doctor, nurse or pharmacist. As an alternative to the signed document, parents could watch a state-issued online educational video about vaccines.

— The information in the exemption forms would go into a confidential statewide database to help public health officials protect people from an outbreak. The database would include personal information but would be subject to federal health privacy laws. It also would include demographic information, most likely age and location, to help public health officials target vaccination programs to areas with lower rates. The legislation says parents can opt out of having their children included in this database (same as they can today with the statewide immunization registry).

— The bill sets a statewide immunization goal of 95%. Colorado’s current vaccination rate for the measles, mumps and rubella vaccine among kindergarteners is 87.4%, one of the lowest in the nation. Proponents of the measure say Colorado could meet the 95% mark without the small percentage of parents who are opposed to vaccines — the legislation is targeting families who are not opposed to vaccines but are too busy, who are behind on vaccinations because of access to health care, or who file an exemption because it is less time-consuming than getting a shot.

— It also says schools and child-care centers must notify parents every year of their vaccination rates.

What’s different this year?

Similar legislation failed last year, and the 2019 debate inspired both sides to show up this year more organized.

Colorado Vaccinates is a coalition that includes the American Academy of Pediatrics, Children’s Hospital Colorado, and several nurses, physicians and public health associations. On the other side, Concerned Colorado is comprised of parents, including many who home-school their children, who believe vaccines are unsafe.

The Senate Health and Human Service Committee hears debate on a bill that would change Colorado’s vaccine exemption rules on Wednesday, Feb. 19, 2020. (Jesse Paul, The Colorado Sun)

An effort last year, which was opposed by Gov. Jared Polis, would have eliminated the personal-belief exemption. The effort was abandoned and instead lawmakers debated, but failed to pass, legislation that would have required that parents get exemption forms signed by a state or local public health agency.

This year’s measure says anyone who gives immunizations can sign the document — including a pharmacist at Walgreens, for example. It also offers the online educational video as an alternative.

Polis’ office recently said he supports this year’s legislation because it “honors the rights of parents while supporting the administration’s efforts to boost immunization rates.” The governor’s budget request for next year calls for $2.5 million for the state health department to increase vaccination rates in Colorado.

A vocal minority?

While a recent survey from Telluride-based Democratic pollster Keating Research showed the vast majority of Coloradans think children should be up to date on vaccines before going to school, most parents who testified were opposed.

Parents said they fear doctors will not sign the exemption forms and said it’s unfair for the state to make them watch a condescending or judgmental video as an alternative. They were also highly concerned about whether the state would keep information in the statewide tracking system confidential.

Several used the terms “bullying” and tracking children “like criminals.”

Sen. Joann Ginal, a Fort Collins Democrat, listens to public testimony on an immunization bill during the Senate Health and Human Services Committee on Feb. 19, 2020. (Moe Clark, The Colorado Sun)

Andrew Roise, a parent and member of Concerned Colorado, said the legislation is only serving to build mistrust, forcing parents to choose between privacy and education. He noted the governor has focused on educating the public about vaccines, and “this bill goes way beyond that. Now we’re registering people?”

Even though the bill says parents can opt out of the registry, Roise considered that a “gray area” and fears that will not be the case. He also wants to ensure that home-schooled children are exempt from the requirements.

He and others in Concerned Colorado are sick of the term “anti-vaxxer,” noting it demeans people who feel passionate about the issue and, in many cases, used to vaccinate their children but stopped doing so after the vaccines caused harm, he said in an interview. “Generally people regard it as a pejorative, and say, ‘Hey, you’re crazy,’” he said.

State health officials, including state Department of Public Health and Environment executive director Jill Hunsaker Ryan, said the state already keeps track of personal immunization and communicable disease data.

Colorado Vaccinates spokeswoman Michele Ames said the bill is good public-health policy and protects the rights of people who don’t want to vaccinate their children. “We assume they are making good choices in the interest of their children,” she said, emphasizing that the bill does not force anyone to vaccinate and allows for opting out of the database. “Unfortunately, the science doesn’t support their choices.”

Lawmakers sponsoring the legislation said they were prepared to hear from a vocal minority who came to the Capitol on a snowy day in protest of vaccines. The legislation, though, is needed to protect infants, the elderly and those who are immune-compromised and cannot get vaccines for medical reasons, such as those receiving cancer treatment.

Sen. Paul Lundeen, R-Monument, speaks as the Senate Health and Human Service Committee hears debate on a bill that would change Colorado’s vaccine exemption rules on Wednesday, Feb. 19, 2020. (Jesse Paul, The Colorado Sun)

“This is a public health emergency that demands our attention,” said Sen. Julie Gonzales, a Denver Democrat. “Our policies are out of step with evidence-based practices.”

Sen. Kevin Priola, a Republican from Henderson and cosponsor of the bill, said he believes a vast majority of Coloradans support tougher immunization requirements. “Vaccines are safe and effective. Period,” he said.

What other vaccine-related legislation is proposed?

A handful of other bills on immunization policy — sponsored by Republicans in a Democratic-controlled statehouse — have already been killed or have yet to get hearings this year.

Senate Bill 84, from Republicans Sen. Vicki Marble and Rep. Lori Saine, would have prohibited an employer — including a hospital — from firing or penalizing an employee or applicant who did not have up-to-date immunization records. An employee who was retaliated against could sue. It died last week in committee.

House Bill 1239, from Republican Rep. Dave Williams of Colorado Springs, would require that patients receive a “vaccination contraindication checklist” and a complete list of potential adverse reactions. Williams’ “Vaccine Consumer Protection Act” also prohibits administering or recommending a vaccine to a child without the parent’s permission.

And House Bill 1297, from Rep. Mark Baisley and Sen. Paul Lundeen, clarifies that a parent’s decision not to vaccinate their children does not constitute child abuse.

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