Who is responsible for enforcing vax laws: Parent, school or state?
Hi Reader. Thanks very much for bringing this article in yesterday’s Arizona Daily Star to my attention, and to Informed Parents of Vaccinated Children for providing the actual link. This well-written article, authored by Rob O’Dell and Stephanie Innes, is overflowing with global issues related to vaccine coverage and placed in the context of the state of Arizona. Therefore, I plan to use it as a framework for the question of who is responsible for following and enforcing vaccination laws. In my interpretation, the article looks at three possibilities: the parent, the school, and the state.
Let’s begin with the parent’s responsibility for following vaccination laws.
There is little doubt in my mind that parents should be able to decide about vaccinations for their children. I cannot imagine the United States ever mandating compulsory vaccination, unless in the case of an act of bioterrorism* or a massive outbreak resulting in a state of emergency. So, the parent is the first line of defense against vaccine-preventable disease, both by getting themselves boosters and by having their children vaccinated. But this assumes that the parent is amenable to the application of reason in their vaccination decision, a trait nearly wholly absent among those who become trapped in the glue of the anti-vax movement. While I do think that most anti-vaccination parents are just like the rest of us in wanting what is best for their children, we diverge immediately after this point, because the anti-vaxxer is not concerned about the health of anybody else’s children. Hence, the parent may be considered a weak and vulnerable cog in the system of enforcing vaccination laws, subject to attack from purveyors of pseudoscientific nonsense.
This quote from the Arizona Daily Star article, from parent and naturopath Tevna Tayler, illustrates the vulnerability of parents to misinformation, especially those heavily invested in the “natural health” movement.
“I felt like the potential risks outweighed the benefits,” she said. “You can die from anything, but I’d rather naturally boost the immune system. In what natural world do you get injected with a strange concoction?”
Interesting. First, Tayler “felt” like the potential risks outweighed the benefits of vaccination. In this, she is wrong. Indeed the argument that “you can die from anything” is very odd in this context and implies that she’s okay with vaccine preventable diseases killing people. But the fact is, I’m not entirely sure where she was heading with this statement.
Anyway, Tayler apparently has a blog in which she sings the praises of “natural” supplements. As we’ve discussed here before, there is nothing natural about supplements, so the question must be asked of Tayler: In what natural world do humans consume copious amounts of pills? Where do the pill bushes grow?
Nonetheless, it must be said that the vast majority of parents get it, even in Arizona, a state that falls at number 13 on the pestilence list. The problem is that a growing number do not, and these folks tend to band together in clusters that cause outbreaks to occur. Further, according to the Arizona Daily Star article, some parents don’t even want to sign the required waivers for vaccinations. This illustrates the weak link that is parental responsibility for vaccinations. While I support parental choice, I think that choice has consequences, and in the future, I think that the consequences should include not being able to attend a school that receives state funding. Which leads us to:
The school’s responsibility in enforcing vaccination laws
All of us who are parents have a vested interest in the safety of our children in school, and in general, we trust our schools to keep our kids safe. Recent national attention has been focused on the possibility of violent acts in schools, such as the horror of a gunman opening fire. There is no denying that the thought of a school shooting should strike fear into any parent’s heart. However, humans are terrible at risk perception when it comes to complex or modern threats to safety. This deficiency allows a much more probable and less front-pagey danger to slip by our worry radar: the danger of a vaccine-preventable disease outbreak occurring in our local schools**.
So, is our trust in our schools well-placed? Again, the Arizona Daily Star article indicates that it is not. Here is a quote from an administrator at a school with the second- lowest vaccination rates in Arizona and where a pertussis outbreak occurred in December 2011:
Administrator Charles Burkam said he didn’t “necessarily see a tie” between the rock-bottom vaccination rates and the outbreak.
Next, we have the director of a Montessori school, arguing that it is not her responsibility to enforce vaccination laws:
“The school’s job is to collect the data [on vaccination rates] and report it,” Khalsa said. The philosophy of the school is that vaccination is “a parent’s choice”.
The authors of the Arizona Daily Star article also highlight the fact that charter and private schools are “by far the worst offenders with unsafe vaccination rates”. Several potential reasons for this have been suggested, including the arguments by the schools that the parents are “educated” about vaccinations…or, as is more likely, the schools are too small to have nurses on staff, and are populated by the children of parents who practice “alternative” lifestyles.
Let me distill this down for you. Some schools in Arizona are either unable or unwilling to support the health of the community by encouraging vaccination. Therefore, we have identified another weak link in enforcement of vaccination laws. Some schools, such as Desert Willow Elementary in Vail, Arizona, are actively pursuing vaccination coverage. But the bottom line is that even with the stars of the vaccination world, it’s the black holes that can pull us all in. Which brings us to:
The state’s responsibility for enforcing vaccination laws
Depending on where you fall politically, beliefs may vary between the state having NO responsibility for maintaining vaccination coverage to the state having ALL of the responsibility. But what does our case study in Arizona indicate is actually happening? Disturbingly, the Arizona Daily Star article asserts that:
No one is enforcing the law. The two state departments responsible for vaccinations – Health Services and Education – point at each other while children go unvaccinated
Is there any truth to this claim? According to Dr. Michelle McDonald, chief medical officer for the Pima County Health Department, there very well may be. She states:
“There is absolutely no consequence to a school if they report [vaccination coverage] or don’t report at all…You have no idea how much work this is, to go to all these schools and get this data. … To not have any consequences for that work is kind of galling.”
Galling? I’ll say. The problem may stem from the existence of many different health authorities, as is the case both at the state and national level. Every state has county health departments and a state health department, which may or not play nicely together. Enforcement of vaccination laws seems most logical at the county level, but this will naturally result in uneven vaccination coverage as some counties are more aggressive than others. State health departments could perhaps take total control over vaccination coverage…if they had laws with some teeth to support them, and, oh yeah, maybe some funding as well.
A case in point is the state of Washington, formerly number one on the pestilence list, which passed a law last summer requiring physician signature on exemption requests. The result? A reduction in the proportion of vaccination exemptions from 6.0% to 4.5%. Sadly, this didn’t happen soon enough to prevent the massive pertussis outbreak rampaging through the state. As I’ve written about before, Arizona is apparently gearing up for some similar changes in legislation. Given the Arizona Daily Star article, it behooves the residents of Arizona to back this bill when and if it comes to fruition.
To me, it seems that the buck is going to have to stop at the state level. This will require legislation that should include a complete ban on philosophical vaccine exemptions, and possibly religious exemptions as well.
Reader, who do you think bears the responsibility for following and enforcing vaccination laws?
*According to D.A. Henderson, leader of the smallpox eradication effort, VP Dick Cheney very much wanted to institute compulsory smallpox vaccination for all Americans back in 2003. Henderson apparently managed to convince (correctly) the rest of the Bush administration that this was not a good idea.
**To those who are planning to wilfully misinterpret what I just wrote, I am not comparing outbreaks of VPD to school shootings. I am saying that in the scope of parental worries, school shootings are a top concern, while fears of a VPD outbreak are rarely, if ever, mentioned, although they are much more likely to occur.