The Michigan House of Representatives: Not the sharpest knives in the drawer.

The Michigan House of Representatives: Not the brightest bulbs on the Christmas tree.

We have a problem with antivaccinationists here in Michigan. It’s a problem that’s been going on a long time that I first started paying attention to in a big way a few years ago when we started seeing pertussis outbreaks again due to low vaccine uptake. It’s a problem that’s persisted as last year we suffered from outbreaks of pertussis and measles, again because of pockets of low vaccine uptake. And what is the reason for these pockets of low vaccine uptake? Well, consistent with what we already know, namely that the risk of pertussis outbreaks is elevated in states where exemptions to school vaccine mandates are easier to get, it’s because our state is one of the worst in the country when it comes to nonmedical exemptions to vaccines. Indeed:

Michigan has one of the highest vaccine-waiver rates for kindergartners in the country, three times the national median, according to the Centers for Disease Control and Prevention. And the number of kindergartners getting vaccine waivers is growing. In five years, it’s increased 23 percent, the CDC says.


As a result, last year the Michigan Department of Community Health altered the rules for obtaining philosophical or religious exemptions from school vaccine mandates. Those who’ve been paying attention to the situation in California will recognize a strategy in these rules very similar to what was passed into law nearly four years ago in the form of AB 2109, a law that mandated that parents seeking personal belief exemptions to school vaccine mandates seek counseling from a physician or other designated health care provider. It’s a law that Governor Jerry Brown sabotaged with a signing statement, thus betraying California children. Fortunately, in the wake of the Disneyland measles outbreak, California passed SB 277, which eliminates nonmedical exemptions to school vaccine mandates.

Issues in California aside, on January 1, 2015, the State of Michigan started requiring that parents seeking a nonmedical exemption to school vaccine mandates for their child were required to:

  • Be educated by a local health worker about vaccines and the diseases they are intended to prevent.
  • Sign the universal state form that includes a statement of acknowledgement that parents understand they may be putting their own children and others at risk by refusing the shots.

Before, all it took was to sign a waiver form, and parents didn’t even necessarily have to use the state form. Now they have to go to the health department in person and receive counseling about vaccines. Basically, this rule change was something that was long overdue, given what a joke Michigan’s rules governing school vaccine mandates had become. It was a rule chance that really pissed off the state’s antivaccine movement, leading some to claim that the health department had broken the law. It hadn’t, as the rules were approved by the Joint Committee on Administrative Rules.

Given how thoroughly our state legislature has been taken over by Tea Party conservatives of the ilk who are very susceptible to what I like to call the antivaccine dog whistle that misrepresents school vaccine mandates as an unacceptable infringement on personal liberty or even incipient fascism (my very own state senator is one of them), I suppose I shouldn’t be surprised that after less than a year it’s already trying to reverse course. I learned this over the weekend when an e-mail was forwarded to me, which I’ll reprint in full:

Parent Voices Needed to Share the Importance of Immunizations

Immunizations once nearly eradicated many diseases from our population, but they’re making a dangerous comeback. In 2014, Michigan had a drop of 5% in the number of children immunized and we now rank 47th in the nation. Michigan has the sixth highest rate of non-medical immunization waivers for kindergarten entry—meaning we have many children entering school who are not immunized.

Two bills introduced this week in the state Legislature would curtail efforts to improve Michigan’s childhood immunization rate and further endanger our most vulnerable citizens. House Bills 5126 and 5127 would eliminate the rule requiring parents seeking non-medical waivers to receive balanced education about the benefits and risks of immunizations from their local public health department. The bills also would strip a local public health department’s ability to exclude children with a communicable disease or those who lack vaccine protection, from attending school during an outbreak.

In light of this new legislation, and ongoing misinformation campaigns from anti-vaccination groups, we are seeking individuals who can speak to how vaccines benefit them and their family. Maybe you have been touched by vaccine-preventable disease or you have an infant too young to be fully immunized. Maybe you have an immunocompromised child or older adult in your life who you want to protect. Maybe you work in the medical field with pediatric cancer or organ transplant patients who cannot be fully immunized for medical reasons. Whatever the reason you feel connected to the issue of vaccination, we want to enlist your help in our efforts to ensure public policy and public opinion reflect the need for strong immunization rates. While we will always provide clear, science-based information about vaccines and vaccine-preventable diseases, we need you to share your real-life examples about how vaccines save lives.

Opportunities to speak could include providing testimony to legislative committees, talking with the press or meeting with individual legislators to talk about your story. We would assist you in crafting your message and arranging these meetings.

If you are willing to be part of this vaccine positive network, or would like to learn more, please send an e-mail to Bree Anderson at banderson@mcmch.org at the Michigan Council for Maternal and Child Health. MCMCH is part of a group of statewide advocacy organizations working together proactively on legislation and policy to improve immunization rates in Michigan.

I think I very well might have to be in touch with Ms. Anderson, and if you’re in the state of Michigan I’d encourage you to get in touch as well. In the meantime, let’s take a look at these bills (House Bill 5126 and 5127), which are now being considered by the Michigan House Committee on Health Policy. In HB 5126, the money quote is here:

(2) A child is exempt from this part if a parent, guardian, or person in loco parentis of the child presents a written statement to the administrator of the child’s school or operator of the group program to the effect that the requirements of this part cannot be met because of religious convictions or other objection to immunization.

(3) THE DEPARTMENT’S AUTHORITY TO PROMULGATE RULES UNDER SECTION 9227 DOES NOT INCLUDE THE AUTHORITY TO PROMULGATE OR ENFORCE A RULE THAT IMPOSES A DIFFERENT OR ADDITIONAL REQUIREMENT FOR A CHILD TO BE EXEMPT FROM THIS PART THAN THOSE DESCRIBED IN THIS SECTION OR THAT REQUIRES THE EXEMPTIONS DESCRIBED IN THIS SECTION TO BE ON A FORM PRESCRIBED BY THE DEPARTMENT.

(4) IF THE DEPARTMENT PROVIDES INFORMATION TO THE PUBLIC ON THE EXEMPTIONS DESCRIBED IN THIS SECTION, THEN WITH THAT INFORMATION THE DEPARTMENT SHALL INCLUDE INFORMATION ABOUT THE EFFECTIVENESS AND POTENTIAL RISKS OF IMMUNIZATION FOR DISEASES ABOUT WHICH THE DEPARTMENT REQUIRES IMMUNIZATION UNDER SECTION 9227.

In other words, this bill is designed specifically, among other things, to reverse the rule change that now requires parents seeking nonmedical exemptions to school vaccine mandates to undergo counseling by a medical professional on the benefits and risks of vaccines and, in particular, the risks of not vaccinating. It gets worse, though:

SEC. 5115A. (1) R 325.175 OF THE MICHIGAN ADMINISTRATIVE CODE IS RESCINDED.
(2) THE DEPARTMENT’S AUTHORITY TO PROMULGATE RULES UNDER SECTION 5111 DOES NOT INCLUDE THE AUTHORITY TO PROMULGATE OR ENFORCE A RULE ALLOWING A LOCAL HEALTH OFFICER WHO CONFIRMS OR REASONABLY SUSPECTS THAT AN INDIVIDUAL ATTENDING A SCHOOL OR GROUP PROGRAM HAS A COMMUNICABLE DISEASE TO, AS A DISEASE CONTROL MEASURE THAT IS NOT IN THE CASE OF AN EPIDEMIC, EXCLUDE FROM ATTENDANCE AN INDIVIDUAL WHO LACKS DOCUMENTATION OF IMMUNITY OR IS OTHERWISE CONSIDERED SUSCEPTIBLE TO THE COMMUNICABLE DISEASE. AS USED IN THIS SUBSECTION, “GROUP PROGRAM” MEANS THAT TERM AS DESCRIBED IN SECTION 9211.

Yes, you read that right. HB 5126 specifically eliminates the authority of the Michigan Department of Community Health to make or enforce a rule that allows a local health official to exclude a child who lacks documentation of immunity from school when a child in that school has a vaccine-preventable communicable disease. So basically, if this law passed, not only would it take us back to the ridiculously easy process for parents to obtain nonmedical exemptions but it would also make it nearly impossible for local health officers to keep unvaccinated children out of school except during an epidemic. Worse, the bill would rescind R 325.175, which reads:

R 325.175 Procedures for physicians and schools for control of diseases and infections.

Rule 5. (1) A physician or other person who attends to a case of communicable disease shall arrange for appropriate barrier precautions, treatment, or isolation if needed to prevent the spread of infection to other household members, patients, or the community. A physician or other person who seeks information on appropriate precautionary measures may request the local health officer or the department to provide the necessary information. Appropriate isolation or other barrier precautions may be instituted for a case or a suspected case of disease, infection, or other condition by the local health officer or the department as necessary to protect the public health.

(2) When a school official reasonably suspects that a student has a designated condition, except for AIDS, HIV infection, and noncommunicable diseases, the official may exclude the student for a period sufficient to obtain a determination by a physician or local health officer as to the presence of a designated condition. The local health officer may initiate the exclusion from school of a student who has a designated condition. A student may be returned to school when a physician or local health officer indicates that the student does not represent a risk to the other students.

You read that right, too. With this part of the state health code rescinded, local health officers would no longer have the authority to keep a child who is ill with a vaccine-preventable disease out of school. At least that’s how it reads to me; let me know if I’m incorrect.

It boggles the mind. It’s unbelievable. Except that it’s not. Believe me, our state legislature right here in Michigan really is that dumb and dysfunctional. I thought it was bad in New Jersey when I lived there, but New Jersey’s got nothing on Michigan.

So who is Rep. Thomas Hooker, who introduced these bills into the legislature? He represents a district near Grand Rapids—oh, CFI-Michigan and Ed Brayton, are you listening?—that is very conservative and very Republican. I couldn’t really find very much about him with respect to vaccine policy except that in September he helped chair a meeting in September of angry antivaccine parents who complained about the new requirement:

Concerned parents came in droves to the state capital Wednesday morning to protest a new vaccine waiver policy which opponents say bullies parents.

But supporters say the new policy, which requires parents to make an appointment with the county health department to officially obtain a waiver, is working. Although some counties had already been doing this, it’s a big change for parents who had previously been able to waive their child’s vaccinations with a quick signature in a school’s office.

Oh, poor parents! They’re being “bullied” because they can no longer just sign a piece of paper and let their children degrade herd immunity and endanger other children with infectious diseases. They actually have to go to the health department and listen to science-based information for 20 or 30 minutes first. Then they can still sign the form and claim the exemption. This complaint is of a piece with other things that antivaccine parents characterize as “bullying,” such as simply questioning their beliefs in the slightest. It’s a refrain that was taken up by the cranks over at Edgy Truth, who are also unhappy at what they see as government overreach. Clearly, it must have been the complaints of these parents that motivated Hooker to introduce these bills and invite a “holistic pediatrician”—hint: run, don’t walk, from any pediatrician who bills herself as a “holistic pediatrician”—Dr. Katherine Ehrlich. If you don’t believe me when I tell you she is antivaccine, just take a look at a link on her website, where she credulously promotes a truly awful “vaxed/unvaxed” study, which was deconstructed a mere three weeks ago!

I suppose I shouldn’t be surprised. Whenever I think the Michigan legislature can’t sink any lower, inevitably it proves me wrong. This time around, in the name of “freedumb,” it’s willing to consider throwing the children of Michigan under the bus because some entitled parents are inconvenienced because they have to go to the county health office to claim a nonmedical exemption based on their pseudoscientific beliefs for their special snowflake. We can only hope that sanity prevails in the House health committee and these misbegotten bills are shot down before they go anywhere. I’m not optimistic. I am, as you can tell, angry, though.

 

 

Posted by David Gorski

Dr. Gorski's full information can be found here, along with information for patients. David H. Gorski, MD, PhD, FACS is a surgical oncologist at the Barbara Ann Karmanos Cancer Institute specializing in breast cancer surgery, where he also serves as the American College of Surgeons Committee on Cancer Liaison Physician as well as an Associate Professor of Surgery and member of the faculty of the Graduate Program in Cancer Biology at Wayne State University. If you are a potential patient and found this page through a Google search, please check out Dr. Gorski's biographical information, disclaimers regarding his writings, and notice to patients here.