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Who is responsible for enforcing vax laws: Parent, school or state?

May 21, 2012

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.

From → vaccines

  1. nicely put. Sharing on IPOVC. Thanksl

  2. Bec permalink

    I just enrolled my son in school and kindergarten. The forms didnt once ask about his vaccination status. This worries me as I have no idea if Im sending him somewhere safe or not. Vaccines should be mandatory in public schools. You cant follow the rules, you cant go. Simple. Obviously there needs to be medical exemptions and religious ones too but those are being abused. You cant just write a letter saying ‘its against my religion to vaccinate’ and be done with it. I think it should have to be applied for, referenced by the head of your church and accepted or denied by whoever governs vaccines in your state. If its denied, no public school for you. You can pay for your child to attend a private school and hope they dont implement mandatory vaccines.

    • Agree on all counts, Bec. Some states have a lot more stringent policies for obtaining exemptions than others. Like you, I believe that every state needs to firm up their procedures–except for Mississippi and West Virginia, which only allow for medical exemptions. I am guessing that you will receive a request for vaccination information by mail before your son actually attends.

      In addition, depending on where you live, you may be able to see vaccination coverage by school online. Failing that, you can call your state health department and ask what the coverage rate is for your school. They may take a few days to get back to you but it’s worth finding out. Another option is to call the school and ask them. Most if not all states require schools to report the number of exemptions so that information should be easy for the school to find.

      I’m with you on the need to know. My kids’ school has a 100% coverage rate…I checked!

  3. I know I’m going to catch some flak over this, but this is my opinion. Religious exemptions should not exist in the context of public schooling. A) There is too much abuse of these exemptions going on. We can make other exemptions harder to get, but people will always have religious exemptions to fall on. B) There is a clear separation of Church and State in this country. If your religion has a practice, e.g. avoiding vaccines, and that practice prevents you from attending public, taxpayer, government regulated school, then go to your Church’s school.

    But that’s just me. And what do I know?

    Again, just to make it clear, this is my opinion and not necessarily that of any of my five employers.

    • You won’t get any flak from me. I agree with you for the reasons that you posted. In addition, the law has upheld your point of view. Freedom of religion does not trump public health.

    • Can’t argue with that, Rene. Safety >>>> religious belief. Public school is a privilege that has some basic requirements for attendance.

  4. darwynnia permalink

    “All of the above”

    The state is responsible for ensuring that the information regarding the vaccine requirements is disclosed to the public in a timely manner to allow time for parents to schedule necessary appointments with their physicians. It is also responsible for surveillance of said requirements and the enforcement of them – including preventing students from attending schools who are non-compliant (no vaccination record and no exemption filed).

    The school is responsible for ensuring that the parents of students enrolled understand the vaccination requirements for attending said school. It is responsible for reporting non-compliant students to the state, and is responsible for reporting any outbreak of a VPD within its halls.

    The parents are responsible for their child’s vaccinations. It is their responsibility to ensure that their child is up to date – preferably fully vaccinated – or have their exemption filed so the state can keep accurate vaccination records for its students in the event of an outbreak of a VPD at the school.

  5. ducatidave permalink

    Just wanted to stop by, Skewed, and provide my annual update. My unvaccinated daughter is now 4 and still perfectly healthy with zero allergies, while her classmates, relatives her age, and peers in general continue suffering a myriad mixture of immunocomprimised and neurologic disorders requiring surgeries, doctor visits, and ever-more medications. Your thoughts?

    • My thoughts? Well, since you asked:

      1. Fascinating anecdote.
      2. Anecdote does not equal data.
      3. You have put your unvaccinated daughter, her classmates, relatives, and peers in general at increased risk for infectious disease, including and especially any newborns in your social sphere.

      I could provide you with countless anecdotes about the superior health and amazing achievements of my perfect (fully vaccinated) children as well. But I won’t, because the fact that my sons are both the best kids on the planet AND vaccinated is irrelevant to this discussion. Thanks for stopping by–although you post far more than “annually”.

      • Chris permalink

        “But I won’t, because the fact that my sons are both the best kids on the planet AND vaccinated is irrelevant to this discussion.”
        :-) … and you are not biased.

        While my sons are driving me crazy (we have to help one move out of his apartment next week), my totally vaccinated daughter has just graduated from high school and scored a 4.0 in her last semester, and at 18 she also has no allergies (not even to studying).

        Oh, and my other son did have surgery recently for hypertrophic cardiomyopathy with obstruction. I am very curious what vaccine ducatidave thinks caused that, because it is generally regarded as genetic. HCM happens to about one in a thousand persons (the obstruction happens in only a quarter of those), and the abnormal muscle growth can start any time from conception to at least age sixty. So there is a real chance that ducatidave’s daughter can development some random ailment that has nothing to do with vaccines (like everything he thinks the classmates have, even without knowing their medical histories).

        • Ha ha! No, I’m undoubtedly biased when it comes to my kids. :)

          I hope that your son is doing well now–how frightening.

      • Chris permalink

        Much better, thank you. He has post surgical cardiac rehab three times a week to help him recover from nine years of a semi-invalid state. Think about “Colin” in the book The Secret Garden, except instead of thinking good thoughts, the recovery comes after surgery removes the bit that can cause sudden death by relearning how to exercise. During that time I surf the web with the hospital’s sometimes iffy wifi.

        It is because of this condition that he gets prophylactic antibiotics before dental cleanings, and has had an annual influenza shot for years. Just another kid who is more vulnerable to random infections than other people.

        I brought it up because I was appalled that ducatidave would speculate on the medical histories of other children.

        • I’m sorry Chris, it sounds like you and your son have had a tough time of it. I hope he continues to get better every day. And I hope you get some rest time as well. It’s got to be tough.

          On a lighter note, Ducatidave is not a person of great mental prowess, so his/her thoughts are nothing to dwell on in any case.

        • Chris permalink

          Actually, we are lucky. His heart condition was found during a routine well child visit instead of after “sudden death.”

          Just a reminder that well child checks are very important. And that there are children in your community with conditions beyond their control that can be affected by a person’s choice to not vaccinate. Like Julieanna Metcalf.

        • Thanks Chris! So glad it was found and treated. Very, very scary, and an excellent reminder of the importance of well checks AND vaccination.

  6. Jordan permalink

    “Dr.” Tevna Tayler. Is just the tip of the Tucson “health alterative.” Just like a sweat lodge and moonlight drumming, are supposed to cure everything from cancer, diabetes to hemmoroids and impotence. Or was it some strange “concoction” of roots and cacti, that is supposed to cure those things?
    I’m no believer of throwing a pill at everything either. But we need to use our BRAINS to find the equal balance. And immunize our children EVERY year! Polio no longer excists, because of immunizations of a “strange concoction. Lets just consider the source.

    • I imagine that the “alternative” stuff is pretty big in the Southwest (I am picturing Sedona here). I am brought back to this excellent quote (I cannot remember the source): “You know what alternative medicine that works is called? Medicine.”.

  7. Jordan permalink

    Yes, alternative medicine is very big in the Southwest. It has to do with a bunch of white men and women. Trying to channel their inner native american. And at the same time, make money.
    They go to a “college” of Homeopathy for 4yrs maximum. Then call themselves “doctors” with a PhD. Licensed to prescribe things, such as medical marijuana. And lobby to have medical insurance pay for their “alternative” treatments.
    I’m sorry to say. I’m a bit more practical than most. And put most, if not all their ideas of cure. On the same level as those that pray for their childs diabetes, etc, to be healed. And instead, watch them die in great agony.

    As far as “Dr.” Tayler is concerned. I do know her and to just read her bi-polar, ADHA, scattered thoughts on her “blog.” Will validate all you need to know, about that source of advice.

    • Thanks Jordan for your post. Quite frankly it is sad that any states recognize homeopaths as anything other than snake-oil sales personnel.

      I just read Tayler’s blog post about how she has decided to do what every other naturopath does and peddle supplements in order to make a buck. The hypocrisy is downright shocking.

  8. Jordan permalink

    Couldn’t agree more.

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