Who knew? Tightening up requirements for personal belief exemptions to school vaccine mandates increases vaccine uptake! [Respectful Insolence]

Michigan is a frustrating state to live in these days. Our state government has just shown itself to be epically incompetent in its handling of the Flint water crisis, which I’ve written about a couple of times before. Our legislature repealed our mandatory motorcycle helmet law, and as a result in this state motorcycles are more donorcycles than ever. Our state has historically had low vaccine uptake, to the point where outbreaks of vaccine-preventable diseases are too common, with pertussis returning with a vengeance. We have naturopathic quacks (but I repeat myself) trying to cure their children of pertussis “naturally,” leading to their great suffering. Meanwhile our state’s personal belief school vaccine exemption rate has stunk and continued to stink. Meanwhile, in 2015 my very own state senator, Patrick Colbeck, mindlessly parrots antivaccine talking points and promises to attend a screening of the antivaccine propaganda film Trace Amounts, and a legislator introduced a bill to make getting personal belief exemptions to school vaccine requirements easier, rather than harder, to obtain.

I needed some good news, and I actually got some!

Remember how, starting January 1, 2015, the Michigan Department of Community Health altered the rules regarding requirements for parents to claim personal belief exemptions to vaccine mandates. Basically, it patterned its policy change on California Bill AB 2109, a bill from a few years ago that sought to tighten up requirements for personal belief exemptions (PBEs) in California. AB 2109 required parents seeking PBEs to meet with a physician or other enumerated health care practitioner to receive counseling on the risks of opting their children out of school vaccine requirements. The physician would then have to sign the PBE form to verify that he had counseled the parents. Of course, in the wake of the Disneyland measles outbreak a year ago, California passed a far stronger measure, SB 277, which, beginning with the 2016-2017 school year, eliminates PBEs in California.

In contrast, Michigan’s change in policy requires parents seeking PBEs to visit their local health department office 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.

So basically, it’s just like AB 2109, except that not just any doctor or nurse will do. Parents have to visit their local health department for the counseling. It’s a creative modification to a strategy designed to make obtaining a PBE at least as difficult as getting one’s children vaccinated. Indeed, part of the problem in Michigan, as in California, is that it’s been easier to obtain a PBE by simply signing a form and sending it to a child’s school than it is to actually get that child vaccinated according to the CDC schedule, or at least according to the requirements of the state school vaccine mandate. Indeed, by last month, it was clear that this new requirement was likely to be effective, given that an antivaccine-sympathetic legislator had introduced HB 5126, a bill designed to strip the Department of Community Health of its power to require in-person counseling before issuing a PBE. Even worse, HB 5126 clearly would make it much more difficult for local health officials to exclude an unvaccinated child from school during an outbreak or even to exclude a child with a vaccine-preventable disease from school.

So has this new rule been effective? A recent news report suggests that it has:

The number of immunization waivers received by Michigan parents is down 39%, a year after a new state rule kicked in requiring parents to attend an information session at their local health department if they want a waiver.

There were nearly 8,000 fewer vaccination waivers for children entering Michigan schools by November of this school year, according to information released this morning by the Michigan Department of Health and Human Services.

The kindergarten waiver rate has decreased from 5% to 3%, the seventh-grade rate has dropped from about 5% to almost 3%, and the rate for new students to a school district has dropped from 4% to 2%.

Michigan in 2014 had the sixth-highest immunization rate in the country for kindergarten students. The waiver rate was particularly high for some counties, where as many as 17% of kids had waivers in 2014.

And:

Statewide, 11,204 students (out of 399,880) had received waivers as of November 2015, for a rate of 2.8%. That compares to the 4.6% rate in November 2014, when 19,152 students (out of 415,891) received waivers.

So, based on this analysis, this temporal correlation between the enforcement of a more stringent standard for vaccine exemptions, the requirement that parents seeking PBEs go to a local health department for 15-30 minute counseling sessions on the benefits and risks of vaccines and, in particular, the risk of forgoing vaccines, has been effective. Statewide, PBE rates have declined markedly since the rule change. In metro Detroit, rates have declined as follows:

• Macomb County: A decrease of 34% — from a waiver rate of nearly 5% (1,656 students) to 3% (1,082) students.
• Oakland County: A decrease of 51% — from 7% (3,821 students) to about 4% (1,866 students)
• Washtenaw County: A decrease of 38% — from 6% (816 students) to 4% (469 students)
• Wayne County: A decrease of 53% — from 5% (3,073 students) to 2% (1,242 students)

In one county (Gladwin) PBE rates have declined by 90%, from 17% to 2% (131 students to 11 students). Unfortunately, PBE rates haven’t declined everywhere in the state. For instance, in Benzie County, the PBE rate went from 1% to 4%. Of course, in absolute numbers, we’re only talking an increase from 6 students to 23 students. So it’s hard to tell if this is a real trend or a one year glitch. Whatever the case, over the state as a whole, in the first year of the new rule, it appears that PBE rates have declined significantly. By any measure, this is good news for the children of Michigan.

If you read the comments after the article, you’ll see that antivaccine activists are trying to spin this result as being due to a decline in kindergarten enrollment. Clearly, these antivaccine activists don’t understand basic math, given that as a percentage of enrolled students PBEs have indeed declined.

Not surprisingly (actually, quite predictably), our local home-grown antivaccine activists are not happy about these numbers at all. Wait, you say. Antivaccine activists nearly always claim they are not “antivaccine.” If that’s the case, then why would they be unhappy that PBE rates have markedly declined since the rule change a year ago? Inquiring minds want to know! For instance, Suzanne Waltman, president of Michigan for Vaccination Choice (whom we’ve met before), is not happy about the now year-old rule. Oh, no. She’s not happy at all:

But Suzanne Waltman, president of Michigan for Vaccination Choice, said parents who opt not to vaccinate their children don’t need to attend an education session.

“We don’t take this decision lightly. We research this information beforehand. We already know the benefits and the risks of vaccinating and not vaccinating and the diseases as well,” Waltman said.

She said the sessions have been one-sided.

“All they’re telling you is the benefits of the vaccination and the risk of the disease. They don’t even tell you about the risk of the vaccination.”

Wait a minute. Did Waltman change the name of her group? When last I wrote about it, her group was called Michigan Opposing Mandatory Vaccines (MOMV). Heck, that’s still the name on the website. In fact, I detest MOMV, so much so that I’ve given the group a bit of the ol’ not-so-Respectful Insolence a few times before. It’s a group that’s a font of antivaccine misinformation. For shame Lori Higgins and the Detroit Free Press, for engaging in false “balance” by interviewing an antivaccine loon like Suzanne Waltman as the opposing voice for an eminently sensible policy such as requiring parents seeking PBEs to be counseled by a public health officer before they can actually claim their PBE for their special snowflake child.

Of course, as I mentioned before, nothing hates success vaccinating children quite like a bunch of “freedom”-loving antivaccine-sympathetic legislators who susceptible to the antivaccine dog whistle that equates vaccine mandates with fascism and PBEs with “health freedom.” So, even as the rule change appears to be working in its first year, we have a bunch of clueless wonders in our legislature (I’m talking to you, Reps. Thomas Hooker, Ray Franz, Ken Goike, Triston Cole, Joel Johnson and Gary Glenn) still working to change that with HB 5126. I’m with the editorial board of MLive on this one and hope this bill dies in committee.

Here’s where the governor could (slightly) redeem himself after the Flint Water crisis. There’s no doubt at all in my mind that our governor, Rick Snyder, has screwed up royally there. There’s just no other way to describe it. However, Snyder’s not always wrong. In fact, on this one issue, the issue of school vaccine mandates, he understands, or at least appears to:

Governor Rick Snyder says the state’s current immunization rule, which requires parents visit their county public health department and talk to a nurse before signing an immunization waiver, is the right way to go. He says it’s a good middle ground between making it too easy for parents to opt their kids out of getting vaccines and completely doing away with Michigan’s philosophical waiver.

I’ve seen other indications that Snyder would probably veto this bill if it came to his desk. In fact, after the Flint Water crisis, I don’t see how he could sign such a bill. Having facilitated a public health disaster in Flint, politically how could he sign a bill to go back to the old ways and perpetuate a low level public health disaster? At least, so I hope. After all, other than emulating California’s more recent banning of all PBEs, what the Michigan Department of Community Health did a year ago, the policy of the state of Michigan with respect to PBEs to school vaccine mandates is as good as it gets. And, as we now know, it works.

Maybe my state isn’t so bad after all, at least not with respect to vaccines. Of course, that remains to be seen. These days, I never underestimate the stupidity and mendaciousness of my state government. It’s not as though, for example, the flu can’t kill or anything.