Top Seattle doctors have issued a controversial proposal that would allow exemptions for vaccines for schoolchildren, except for the shot that prevents measles. This could preserve liberty and ensure higher vaccination rates overall, they write.
Amid growing calls to limit vaccine exemptions for children in public schools, several Seattle doctors have come up with a controversial plan: Allow personal and religious opt-outs for all shots — except the one that prevents measles.
The proposal, published Friday in the journal Pediatrics, flies in the face of current thinking by many medical experts and some lawmakers, like those in California, who passed one of the nation’s strictest vaccination laws, prohibiting nonmedical exemptions.
But Seattle Children’s expert Dr. Douglas Opel and his colleagues, including Dr. Jeff Duchin, health officer for Public Health — Seattle and King County, argue that the well-meaning trend not only infringes on personal liberty, but, more important, it doesn’t work.
“We’re realizing that it’s not a scientific and ethical approach,” said Opel, who specializes in pediatrics and bioethics. “This is less about letting parents choose than about developing sound, sustainable policy.”
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Instead of focusing on taking away parents’ right to opt out of vaccination, the doctors say, policymakers should focus on enforcing current immunization mandates and on containing the public-health threat posed by the riskiest vaccine-preventable pathogen: measles.
The measles virus is more contagious than other bugs, such as pertussis, and it poses a serious public-health burden with severe, even deadly, disease, frequent outbreaks and high costs to contain the spread, the authors contend.
The vaccine to prevent measles is safe and effective, Opel said, but it requires a high level of community immunization — an estimated 92 percent to 94 percent — to prevent transmission.
“We believe a policy to eliminate nonmedical exemptions (NMEs) from measles virus alone is more justifiable, sustainable and enforceable than eliminating NMEs from all vaccines,” Opel and his colleagues wrote.
The proposal drew a quick rebuke from officials at the American Academy of Pediatrics, who said the threat from measles is not unique and efforts to single out that disease could backfire, making parents question the usefulness of other shots.
“Far from being unique to measles, the threat to public health and the safety of available vaccines are factors that characterize all vaccine-preventable infections,” wrote Dr. Carrie Byington, chair of the AAP’s committee on infectious diseases, and colleagues. Their response was published in the same journal.
And the plan wasn’t popular with vaccine critics, either. Michael Belkin, a Seattle-area father whose infant daughter died in 1998 after receiving recommended shots, said the new proposal is more restrictive than current vaccine requirements.
“It would strip parents of their right of informed consent — and it will face a concerted grass-roots opposition by parents who read the Food and Drug Administration (FDA)-required vaccine package insert and see that the authors’ claim that the measles vaccine is safe is patently false.”
Belkin points to potential risks detailed in the FDA inserts, including encephalitis, and notes that the Centers for Disease Control and Prevention lists seizures, coma and permanent brain damage as potential risks from the measles, mumps and rubella, or MMR, vaccine.
In Washington state, children who attend public school or day care must be immunized against 11 vaccine-preventable diseases, including measles.
Students may be exempted from the immunization rule if their parents object for medical, philosophical or religious reasons and if they obtain a note or state form signed by a health-care provider. A move to eliminate the personal-belief exemption failed in the state Legislature last year.
About 3.5 percent of children in Washington have exemptions on file, said Duchin. But about 15 percent of kids are simply not up to date on their shots. Their parents don’t necessarily object to the vaccinations, they just haven’t taken steps to make sure the kids are fully immunized.
Before eliminating all nonmedical exemptions to vaccines, it makes more sense to focus on ways to enforce compliance, said the proposal authors. They included Dr. Ed Marcuse, a professor emeritus of pediatrics at the University of Washington; Dr. Matthew Kronman and Dr. Douglas Diekema of Seattle Children’s; and Dr. Eric Kodish of Cleveland Clinic.
In the meantime, eliminating nonmedical exemptions just for measles could help contain disease while still preserving parents’ rights, Duchin said. Parents shouldn’t mistake the proposal as suggesting that vaccines other than the measles shot aren’t important, he noted.
“The message for parents is all children should get recommended vaccines. This message is targeted to policymakers,” he said. “This article is trying to understand what’s the best way to get the most possible kids immunized.”