Vaccine Requirements — Parental Rights vs. Public Safety

I added an Addendum to this post.

Last week a public hearing was held on HB416 which would provide an exemption from required vaccinations for reason of “conscientious belief”.  Such exemptions are not uncommon.

A parent or legal guardian objects to immunization because of conscientious beliefs. The parent or legal guardian shall sign a form that shall be witnessed by a health care provider or notary public stating that the child has not been immunized because of conscientious beliefs. (from HB416)

In a letter to the committee  Kelly M Nordstrom, a pediatric nurse practitioner, addressed the key argument of “choice” advocates, explaining why rights/choices are limited and not absolute.

…..Parents have the choice. What this is about, really, is whether or not they will be allowed to participate in public education with or without adequate vaccination. Parents are absolutely empowered to make health care decisions for their child, and to refuse vaccinations. Just as their child would not be allowed to attend school with a febrile illness, their child will not be able to attend school without proof of vaccinations. This is not only to protect their child, but to protect all the other people they come in contact with. The Immunization program in NH protects pregnant teachers against contracting varicella or measles, it protects the infant of a parent volunteering in the classroom from contracting pertussis, it protects their friends and neighbors. Vaccination keeps these “eradicated” diseases from re-emerging in the United States…..

via Blue Hampshire: Politics ::: Why I Oppose HB416.

It is tempting to agree that an exemption, say because of religious belief, should be allowed even if there is some public risk.  The conscientious beliefs of many of those opposing vaccination turns out to rest on clearly mistaken beliefs.  For example, the alleged link between autism and vaccination is based on a single, faulty  study.

An Addendum (4/9/11)

Abigail Zuger has written a review of Seth Mnookin‘s new book, The Panic Virus: A True Story of Medicine, Science, and Fear.

What caught my attention was her framing of the problem.   She starts off her review by questioning the need for more talk about “the repeatedly debunked claims linking childhood vaccinations and autism”.

Barely a dozen pages in, I began to reconsider, and by the end I had completely changed my mind: Mr. Mnookin’s passionate defense of vaccination may be just what the public needs, in equal parts because of what it says and because of who is saying it. (emphasis is my own)

Who is Seth Mnookin?  He is not an expert in medicine nor a scientist.

He hails instead from what might be called, sadly enough, exactly the opposite demographic: he is young and hip, got a good liberal arts education, lives in an upscale enclave and works in another, as a contributing editor of Vanity Fair. He is the father of a young child. And it is people of precisely this description who are slowly picking apart the safety net that protected their own childhoods, prompted by a well-intentioned mixture of arrogance, ignorance and confusion.

Is this the “question authority” demographic?  It seems so. The value of Mnookin’s book is in part because he is a peer rather than an outside expert. As she puts it: “Expert opinion seems to have oddly little influence over these parents…”.

Why do experts have so little influence?  Are their arguments incomprehensible?  Do parents who reject vaccination distrust scientific and medical experts? It is a question of argumentative style?

It certainly doesn’t hurt that Mr. Mnookin has put it all together in a readable narrative encompassing celebrity high jinks worthy of Vanity Fair at its snarkiest. via ‘The Panic Virus’ Review – Seth Mnookin on Vaccines and Autism – NYTimes.com.

I don’t have any answers. I am perplexed.  To say, as I am tempted to say, that the issue comes down to what sources of information you trust and which sources you mistrust (better, who you trust and who you do not trust), fails to explain why intelligent individuals make poor decisions.

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2 Responses to Vaccine Requirements — Parental Rights vs. Public Safety

  1. An update. The Committee voted 8-3 to send the legislation to the House floor as “Inexpedient to Legislate” and the House adopted the committee report 215-149.

    Details below.

    HB 416, adding an exemption from immunization for conscientious beliefs. INEXPEDIENT TO LEGISLATE.

    Rep. David S. Robbins for Children and Family Law: The proposed law would add an exemption for conscientious belief to the NH requirement that all children be immunized for attendance at public schools and licensed day care facilities. Currently NH requires a series of vaccinations and boosters for entry to and continued attendance at public schools and licensed day care facilities. There are now two exemptions: medical and religious. A medical professional can assert that a specific vaccination or vaccinations should be delayed or proscribed due to a temporary or ongoing medical condition. Parents may assert that vaccination violates a religious tenant. NH law is silent on whether the religious exemption allows the parents to choose administration of some, but not all, vaccinations. Testimony before the committee indicated that some, but by no means all, medical professionals were reluctant to administer selective immunizations. Further testimony indicated that parents could, if they chose, find medical professionals who would administer vaccinations selectively. The committee believes that immunization requirements for attendance at public school and licensed daycare are appropriate and necessary for the public good. We received testimony indicating increased outbreaks of pertussis and other contagious diseases in states and countries with decreased immunization rates. Conversely, there was lower disease incidence in states and countries with high immunization rates. Further testimony indicated that effective group protection required very high, but not total, immunization rates. A small percentage of unimmunized individuals did not threaten the health of the group. However, beyond a certain threshold (the limit of herd immunity) infection rates increased dramatically.

    The committee heard the anguished, passionate, frustrated, philosophical, constitutional and health-based arguments offered by parents and professionals supporting an exemption as a right of conscience. They were compelling and well-articulated. The committee did not and does not dismiss or minimize them. They come from a genuine concern for children’s health and the right of parents to make choices for their children.

    The committee concluded that there was compelling, overwhelming medical evidence that vaccinations were effective and current law served the public good. Allowing a third exemption would threaten public health. We further concluded that while vaccinations have some risks of adverse consequences, the public good outweighs the individual risks. Parents may choose which, if any, vaccines their children receive. They have school choice options including private, parochial and/or home schooling. The committee believes these options provide a balance between group health and a parent’s right to choose what they believe best for their children. Vote 8-3.

  2. Impressive summary and the decision is well grounded and “reasonable”. It shows the importance of the public hearing which permitted all sides to be heard, including Kelly M Nordstrom, the nurse practitioner I quoted from in the main article.

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