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May 19, 2019

5/11/2019 7:30:00 AM
Lawmaker's bill would end personal conviction exemption from vaccination
Study: Careful assessment needed before early vaccination

Richard Moore
Investigative Reporter


State Rep. Gordon Hintz (D-Oshkosh) has re-introduced legislation to eliminate the personal conviction waiver from the state's vaccination requirement, a step he calls a proactive measure, given that hundreds of measles cases have been reported in the U.S. in early 2019.

As of May 3, the Centers for Disease Control confirmed 764 individual cases of measles in 23 states since the beginning of the year. That was an increase of 60 cases from the previous week, and marks the greatest number of cases reported in the U.S. since 1994 and since measles was declared eliminated in 2000.

However, as of this writing, no cases have been reported in Wisconsin. Most of the cases have been reported in New York.

Hintz calls the national outbreak a growing public health crisis.

"This legislation is about preserving public health in Wisconsin," Hintz said. "It is about protecting our children. With outbreaks nationwide and in our neighboring states, it is only a matter of time before our dropping immunization rates result in a measles, or other infectious disease outbreak somewhere in Wisconsin."

Hintz said states with better requirements for vaccinations have higher vaccination rates and fewer occurrences of outbreaks.

Still, it's not clear that Hintz's bill would help prevent any measles outbreak in Wisconsin. In New York, where most of the cases have occurred and which does not have a personal conviction exemption, the vast majority of cases have involved members of the Orthodox Jewish community.

New York does have a religious conviction exemption, as does Wisconsin. Hintz's bill would not remove that exemption.

However, Hintz said, Wisconsin has one of the broadest exemptions of any state in the country, which makes it easy to opt out of vaccinations. Twenty years ago, he said, just 1 percent of Wisconsin children were opted out of vaccines, while state health records showed that 5.3 percent of Wisconsin children had been opted out of vaccinations by their parents last year, more than double the national average.

In the same report, Hintz said, over 90 percent of vaccination waiver exemptions were for "personal" reasons.

"Vaccinations are a public health issue and not just a parental right," he said. "The decision to forgo vaccination poses a threat to others. Especially babies too young to be vaccinated or those who can't be vaccinated for health reasons."

Vaccination is not just about protecting individuals, Hintz said.

"It is about protecting everyone," he said. "People who choose to opt out of vaccinations are only protected by those who are vaccinated and reduced their risk of exposure. Our numbers are heading in the wrong direction, and it is time to act and close the personal waiver loophole."

Rep. Debra Kolste, a co-author of the bill, said the rise in preventable disease outbreaks is directly tied to lower vaccination levels.

"We should not be putting adults, children, and those with compromised immune systems at-risk for hospitalization simply because someone doesn't want to receive a vaccination," Kolste said. "Federal health officials are currently trying to stem one of the worst measles outbreaks in decades with 700 cases already confirmed for 2019. Wisconsin needs to be proactive and do everything possible to prevent an outbreak from occurring."

An array of organizations representing the state's medical establishment joined in giving support to the legislation, including the Wisconsin Medical Society, the Wisconsin Chapter of the American Academy of Pediatrics, the Wisconsin Public Health Association, Children's Hospital of Wisconsin, Medical College of Wisconsin, the Wisconsin Association of Local Health Departments and Boards, the Wisconsin Nurses Association, and Aurora Health Care.

Wisconsin Medical Society president Chip Morris said the group was very pleased to see bipartisan introduction of the bill.

"We're seeing the worst outbreak of measles in the United States in decades and, at the same time, more and more Wisconsin school kids don't have the vaccinations currently required by state law," Morris said. "This is a very dangerous combination, and it's wise that Wisconsin join with a majority of states in the nation in removing the 'personal conviction' exception to following the law."

Vaccinations are a public health marvel, Morris said.

"They are safe and amazingly effective," he said. "We need more people vaccinated, not fewer, and this bill would help us do a better job protecting our kids and our most vulnerable citizens from serious diseases that are preventable."

Gov. Tony Evers has also announced his support for the bill.



Big push for vaccination

Meanwhile, the bill to end the personal conviction exemption is not the only effort being made to increase immunization levels, both legislatively and by medical institutions themselves.

The CDC itself is urging parents to vaccinate their children, for example.

"This current outbreak is deeply troubling and I call upon all health-care providers to assure patients about the efficacy and safety of the measles vaccine," said CDC director Robert Redfield. "And, I encourage all Americans to adhere to CDC vaccine guidelines in order to protect themselves, their families, and their communities from measles and other vaccine preventable diseases. We must work together as a nation to eliminate this disease once and for all."

Hospitals, too, have been sending letters to patients urging vaccinations for the entire family, and another bill in the Legislature, in an attempt to expand access, would allow pharmacists to vaccinate children of any age.

According to an analysis by the Legislative Reference Bureau, the bill, authored by state Sen. Patrick Testin (R-Stevens Point) and Rep. Tony Kurtz (R-Wonewoc), would eliminate any patient age restriction for the administration of a vaccine by a pharmacist if the vaccine is administered pursuant to the prescription order of a physician or other prescribing practitioner issued within the 29 days immediately preceding the day on which the vaccine is administered and the pharmacist has satisfied certain education requirements.

The bill also provides that a pharmacist or a pharmacy student under the direct supervision of a pharmacist may administer any vaccine that is listed in the immunization schedules published by the federal Centers for Disease Control and Prevention and any vaccine not so listed if administered pursuant to a prescription order of a physician or other practitioner.

At a hearing on his bill, Testin said his bill would especially improve access to vaccinations for children in underserved areas, particularly in the rural areas of the state.

An earlier version of the bill was opposed by some in the medical community, Testin testified, but he said those objections had been resolved and that the Pharmacy Society of Wisconsin, Walgreens, and Concordia University all supported the bill.

Testin said the bill requires administering pharmacists to have received training in how to administer vaccines to children under the age of six.

Kurtz also testified, saying the bill would turn words into action.

"Often times when we are discussing health care policy in this building, the words 'access' and 'affordability' get tossed around," Kurtz testified. "This bill helps to address those words."

Kurtz also said more than half of all states already allow for pharmacists to vaccinate children of any age.

The Wonewoc lawmaker said the bill would also tighten up reporting of immunizations to help the state know exactly who is and who is not vaccinated.

"Additionally, this bill would call for the pharmacist who performs the immunization to submit the record to the Wisconsin Immunization Registry," he said. "Currently, this is not done universally. By adding this requirement, a patient's doctor and a patient's pharmacist can see the immunization status for that individual."

Kurtz said that is already mandated for Medicaid patients, so it would not create an undue burden for the pharmacist to do so, and he said it actually would provide consistency for patients across all health plans.

"The real-world applicability would mean that more people in less populated areas would be able to have access to immunizations, regardless of age," he testified.



Early vaccination risk

Meanwhile, a new study conducted by Iris Brinkman of the Centre for Infectious Disease Control in the Netherlands and Dr. Robert S. van Binnendijk of the National Institute for Public Health and the Environment suggests that early vaccination without a good reason - such as international travel or an immediate outbreak - may not be a good idea.

According to the study, early measles vaccination provides immediate protection in the majority of infants, but long-term neutralizing antibody responses are reduced compared to infants vaccinated at a later age.

"Additional vaccination at 14 months of age does not improve this," the study concluded. "Long-term, this may result in an increasing number of children susceptible to measles."

The authors acknowledged that the majority of infants are not protected by maternal antibodies until their first measles vaccination between 12 and 15 months of age and that provides an incentive to reduce the age of measles vaccination.

Still, they state, the immunological consequences of early vaccination are insufficiently understood and the long-term effects are largely unknown.

In the study, the researchers compared infants who received early measles vaccination between six and 12 months and a second dose at 14 months of age with a control group who received one dose at 14 months of age. Measles-neutralizing antibody concentrations and avidity were determined up to four years of age.

What they found was that infants with a first measles vaccination administered before 12 months of age showed long-term reduced measles-neutralizing antibody concentrations and avidity compared to the control group.

"For 11.1 percent of children with a first dose before nine months of age, antibody levels had dropped below the cutoff for clinical protection at four years of age," they found.

That doesn't mean children shouldn't receive an early measles vaccination when an outbreak occurs, the researchers stated, but every situation should be thought through carefully.

"In conclusion, we showed that early measles vaccination induces protective antibody responses in the majority of children measured at 14 months of age," they wrote. "This is expected to protect infants in an outbreak setting. However, reducing the age of the first measles vaccination should be carefully assessed per situation, because of concerns with respect to long-term protection as the susceptibility for measles virus infection may increase with age, with a potential impact on herd immunity in the population."

The observations that antibody levels for a proportion of children vaccinated below nine months of age had already dropped below the cutoff of clinical protection at four years of age despite being vaccinated twice supports this notion, they wrote.

"Reduced protection in early-vaccinated individuals may contribute to an already decreasing vaccination coverage, and increase the risk of future epidemics," they concluded.



Vaccine injury

Though health officials maintain that vaccines are safe and rarely mention risks in their public pleas, there are real risks, though statistically the risk of vaccine injury is small, according to government data.

As of January 2 of this year, the federal Vaccine Injury Compensation Program has compensated 483 people for vaccine injury after a measles vaccination. All totaled in the program, 1,258 claims were filed for 82 deaths and 1,176 injuries after vaccination with a measles, MR, MMR, or MMR-V vaccine.

In 2018, at a Florida law firm, Maglio Christopher & Toale, attorneys negotiated a $101-million settlement for an infant who suffered a severe reaction to the MMR vaccine. According to the firm, the child was a one-year-old healthy baby girl who was already walking and climbing.

"On February 13, 2013, she received vaccinations for Measles Mumps Rubella (MMR), Hepatitis A, Haemophilus Influenzae type B (Hip), Prevnar (pneumonia), and Varicella (chickenpox)," the firm stated in a release about the settlement with the vaccine court. "That evening, the mother noticed the baby was irritable and feverish. After a call to the pediatrician, the doctor advised Mom to give her Tylenol and Benadryl."

The fever continued for several days and on the evening before her scheduled pediatrician visit, she began having severe seizures, the law firm stated.

"She was rushed to the emergency room," the firm recounted. "[The baby] went into cardiac and respiratory arrest and doctors placed her on a ventilator. The seizures and cardiac arrest left [the baby] with a severe brain injury, encephalopathy, cortical vision impairment, truncal hypotonia (low muscle tone), and kidney failure. After months of treatment at the hospital, [the baby] finally went home, but her disabilities require specialized medical care and supervision around the clock for the rest of her life."

The $101-million settlement pays for the child's constant high-level medical care needed for the rest of her life, the firm stated. The family received a lump sum of $1 million dollars to cover the immediate costs of medical bills and expenses, with the rest paid out through an annuity over the child's lifetime.

According to the CDC, MMR vaccine has also been linked with a "very small" risk of febrile seizures (seizures or jerking caused by fever), which are not associated with any long-term effects. Rarely, the CDC reports, a person may have a serious allergic reaction to MMR vaccine, adding that anyone who has ever had a life-threatening allergic reaction to the antibiotic neomycin, or any other component of MMR vaccine, should not get the vaccine.

Richard Moore is the author of the forthcoming "Storyfinding: From the Journey to the Story" and can be reached at richardmoorebooks.com.





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