Anti-Vax Parents Sustain Californians' Goofy Reputation

They turned the country up on its side, and everything loose fell into California.

———Frank Lloyd Wright (attributed)

The Pathophilia blog lost its most recent breakfast, lunch, and dinner after reading today's NYT article on the rejection of vaccination by some terribly misguided parents, who happen to live in (shock of shocks) California. Probably most disconcerting is the photo accompanying the story, in which San Diego vaccine rejectionists Linda Palmer, Julie Chiariello, and Sybil Carlson look so damn shiny, happy, and casually Californian while putting their and other children at risk for potentially deadly infectious diseases.

To America's misfortune, these clueless women have bred (why yes, I am a harsh bitch, but justifiably so) and have elected to eschew vaccinations for their kids on the basis of a "personal-belief exemption" to California law that otherwise requires routine inoculations. This is an exemption that is separate from, more or less, a religious exemption to vaccination. Electing to take the personal-belief exemption—which is surprisingly easy in some states—is often based on the not-just-unfounded, but disproven, idea that vaccination increases the risk of autism.

The problem with the terribly misguided public policy of allowing personal-belief exemptions is that, not only are the vaccination-exempt children susceptible to illness, they pose an infectious risk to children too young to receive vaccines and to those children who have already been vaccinated. The NYT article points out that the measles vaccine, as an example, is not 100% effective at preventing the disease.

This fact was recently illustrated when 2 measles-vaccinated college students in Texas contracted the disease from a traveling sales rep who acquired the infection from a Japanese player at last year's Little League World Series in Pennsylvania. In 1989 and 1990, a measles outbreak in San Diego affected hundreds of children and caused 3 deaths; all of the children who became ill were either unvaccinated or too young to be inoculated. The San Diego outbreak is a sober reminder that measles is not necessarily a benign childhood illness.

According to the Johns Hopkins Institute for Vaccine Safety, 48 states allow religious exemptions to vaccination (Mississippi and West Virginia do not, and I'll never say anything bad about either state again), and 21 states allow for personal-belief exemptions as of January 2007 (the parade of state shame is provided below and, sadly, doesn't merely include our loopy western states). The distinction between religious and personal-belief exemptions is downright murky, as the latter can include "religious, philosophical, and any other unspecified nonmedical exemption." Also a religious exemption to vaccination can be taken on the basis of a personal belief that is not necessarily religiously founded, as in Maryland.

States That Allow Personal-Belief Exemptions to Vaccination: Arkansas, Arizona, California, Colorado, Idaho, Louisiana, Maine, Michigan, Minnesota, New Hampshire, New Mexico, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Texas, Utah, Vermont, Washington, and Wisconsin.

The ease with which a personal-belief exemption can be taken varies widely from state to state. According to a 2006 JAMA study, a California parent simply has to sign a prewritten statement on the school immunization form, and signing this form is much easier than filling out the immunization record, which typically requires the assistance of a health care professional. In other states, taking the personal-belief exemption is more difficult and requires "a signature from a local health department official, annual renewal, notarization, or a personally written letter from the parents explaining the reasons for vaccine refusal."

Not surprising, the rates of nonmedical exemptions are higher in states that permit personal-belief exemptions and higher still in those states that easily grant the exemptions. The danger of providing personal-belief exemptions and their easy access is demonstrated in the JAMA study, which found that the incidence of pertussis* (ie, whooping cough) in states allowing personal-belief exemptions is more than 2 times the incidence in states allowing only religious exemptions. The incidence of pertussis in states granting easy access to a personal-belief exemption is 90% higher than that in states with more difficult procedures to become exempt. The study defines the following states as providing easy access to exemption (but these states do not all provide personal-belief exemptions): Alaska, Arizona, California, Hawaii, Idaho, Maryland, Michigan, Missouri, Oklahoma, Oregon, Pennsylvania, Rhode Island, Vermont, Washington, and Wisconsin.

Other horrifying information from the NYT article is the hosting of disease parties by anti-vax parents, where their unvaccinated children are exposed to viruses like varicella or measles (presumably from an already sick child in attendance) in an effort to develop natural immunity. I have no idea why this activity doesn't constitute child endangerment. To justify the parties, Linda Palmer gives the following eye-rolling quote to the NYT, which was no doubt delivered with all the insensible calm that befits it: "It is a very common thing in the natural-health oriented world." (So is mumps orchitis, but try explaining that to your boy.) Palmer, however, decided against sending her son to a measles party, with the excuse that she feared her son would be ostracized if he became ill, not that she feared her son would become ill.

Even more disturbing is the tolerance of an anti-vaccination attitude by some physicians. The NYT interviewed San Clemente pediatrician Robert W. Sears, who admitted that vaccination should not be mandated. He acknowledged that approximately 20% of his patients are not vaccinated and that another 20% are only partially vaccinated. With statistics like those, it behooves Sears to post infectious-disease warnings in his waiting room.

One issue not addressed in the NYT article is that of liability, should a vaccinated child or a child too young to receive vaccination acquire a preventable infection from a child who has not been vaccinated on the basis of a personal-belief exemption.

*If only I could mandate that Linda Palmer, Julie Chiariello, Sybil Carlson, and like-minded parents watch this video on a loop until they come to their senses.