May 15, 2011

State tightens rules for parents seeking to exempt kids from immunizations

Vaccine exemptions now require a doctor's note

OLYMPIA -- State Rep. Barbara Bailey knows the difference a vaccination can make.

As a child, she watched a classmate die of polio. And Bailey survived her own difficult battle with whooping cough.
Those memories are why the Oak Harbor Republican helped pass a new law signed by Gov. Chris Gregoire on Tuesday that requires parents to sit down with a doctor before deciding whether to exempt their children from getting immunized.
"I don't want to see any family or community lose an infant or child from a disease that can be easily avoided if the proper steps are taken," she said. "The whole point of this bill is to help parents be well-informed when they make their decision to immunize or not immunize."

Opponents insist the new law coerces parents into pricey visits with health care professionals where they will be pressured to do something they don't want to do.

"We see this as part of a growing push to get more vaccines into kids and fewer options to parents to not get vaccinated," said Ezra Eickmeyer, who lobbied against the bill on behalf of the National Vaccine Information Center. "This bill looks very challengeable in court."

Today, when parents or guardians enroll their child in a public school they must provide either proof of immunization or a signed certificate indicating why they are not getting vaccinations.
 They can object on medical, religious or philosophical grounds.

In the past decade, the number of exemption certificates submitted has more than doubled statewide with the vast majority being for personal reasons, said Michele Roberts, communications manager for the state's Immunization Program. Washington ranks among the highest of all states in its rate of exemptions among school-age students, she said.

Under the new law, which takes effect July 22, those exemption certificates must be signed by a health care professional such as a pediatrician, licensed naturopath, licensed physician assistant or advanced registered nurse practitioner. This does not apply to those who belong to a church with teachings that preclude a health professional from providing medical treatment to the child.

Supporters say this will ensure parents talk about the pros and cons of immunization with a medical professional before acting. Under the law, they can still choose not to immunize afterward.
"It's a professional opinion they are supposed to get," said Dr. Roger Case, health officer for Island County.

There's concern in the health community about a resurgence of childhood diseases and parents not fully understanding the threat because they've grown up in an era without polio and measles.

Yet earlier this year, there were two cases of measles in southwest Washington, one in an infant and one in a teenager. Both recovered.*
"We've become a little bit complacent forgetting how those diseases can kill children," Bailey said.
Backers also hope this law helps curb the number of exemptions filed by parents because it's easier then trying to dig up immunization records.

"The aim is to distinguish exemptions for conviction versus exemptions for convenience," Roberts said.

Pediatricians and school nurses have lobbied for a version of this bill for the past couple of years. As other states tightened their rules for exemptions, Washington remained one of eight allowing parent signatures on the certificates and one of 20 allowing philosophical as an objection.

"We are definitely in favor of this as it could significantly reduce the number of students who, because of the existing exemption option, do not have needed immunizations," said Jim McNally, who supervises the Everett School District's school nurse program. "This will help in our efforts to reduce the risk of communicable illnesses that can be prevented by appropriate and timely immunizations."

Eickmeyer said the law seeks to solve a problem that doesn't exist. The rate of vaccination of children in Washington against the most serious, life-threatening illnesses is on par with the rest of the nation, he said.

When a parent chooses some but not all vaccinations for their children they get counted as an exemption, pushing that number higher, he contended.

"Vaccination does not guarantee immunization," he said. "What this law is really about is an initial assault to eventually get rid of the philosophical exemption. It is a line in the sand."

Dr. Wendy Sue Swanson, a pediatrician at the Everett Clinic who writes a blog on medical issues, said a safer and informed community is the only goal.

"This is not by any means meant to be heavy handed. It is meant to clarify what a true exemption is," she said, shortly before a 1-year-old patient arrived for a vaccination. "This is really about helping a family make a good decision.

"We are not just affecting our children," she said. "We are affecting the community in which we live."
Jerry Cornfield: 360-352-8623;
Correction, May 11, 2011: An earlier version of this story stated incorrectly that the measles cases earlier this year were fatal. Post Polio Litaff Association, A.C, only  provides information and is neutral in other countries desitions.

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