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Vaccination debate pits public health vs. personal liberty

By MICHAEL COUSINEAU
New Hampshire Sunday News

October 06. 2012 8:01PM
Click above for a larger image. (PARADE)
About 1 in 45 New Hampshire kindergartners used a religious or medical exemption to avoid getting required immunizations to attend classes last school year - a rate higher than in 30 other states.

And a battle pitting public health vs. parental rights over vaccinations may reignite at the State House again in the coming months.

Public health officials say they are concerned about a Litchfield legislator's promise to push a bill again next year that would exempt parents from vaccinating their kids 'because of conscientious beliefs.'

'That may tip the balance to be something we really are concerned about and should be concerned about,' said Marcella Bobinsky, the state immunization program manager at the Division of Public Health Services. 'If the exemption rate does rise, that is something communities should be concerned about.'

The more people vaccinated, she said, the smaller the chance of a disease entering a community and making people sick, a principle called 'herd immunity.' (Related story inside PARADE)

But Rep. George Lambert, R-Litchfield, who sponsored a 2011 bill to broaden the exemption, said parents should have the final say over whether their children are vaccinated.

'It's one of the only health care treatments in the United States that you can't decline,' said Lambert, who plans to reintroduce the bill next year if reelected in November.

He said a religious exemption blocks all vaccines, whereas his exemption would allow parents to reject specific vaccines.

A national survey showed 26.6 percent of respondents expressed a concern over the value and safety of vaccines. And 19.5 percent said they questioned or refused doctor-recommended vaccines for themselves or their children, according to a Thomson Reuters-NPR Health Poll released in 2011.

During the 2011-12 school year, parents in New Hampshire obtained 251 religious exemptions and 34 medical ones for their children in kindergarten, or a total of 2.2 percent of the state's 13,022 kindergartners, according to the Centers for Disease Control and Prevention. Eighteen states reported higher rates, led by Alaska at 7 percent. Wyoming didn't submit statistics.

Some children are granted medical exemptions because they have cancer or leukemia and can't receive the vaccines, Bobinsky said. A doctor typically writes a letter on official letterhead that is given to the school, she said.

To get enrolled in kindergarten in New Hampshire, children are required by state law to be immunized against nine diseases, including polio, hepatitis B and chicken pox, Bobinsky said. That typically means 19 shots and three oral doses, starting with hepatitis B at birth, she said.

Within the last 10 years, the state required kindergartners to get a second dose of the vaccine for measles, mumps and rubella as well as two doses of vaccine for chicken pox. The state within the last five years also required children before age 11 to get a Tdap shot covering diphtheria, tetanus and whooping cough.

Anyone seeking a religious exemption in New Hampshire must sign a form that states: 'The administration of immunizing agents conflicts with the religious beliefs of the parent or legal guardian of the student listed above. I understand that in the event of an outbreak of vaccine-preventable disease in my child's school or child care facility, the state health director may exclude my child from the school or child care facility, for his own protection. This exclusion will last until an incubation period from the last identified case of the communicable disease has passed.'

State Public Health Director Jose Montero said he doesn't think there's a trend toward more parents seeking exemptions in New Hampshire, but he said health officials do need to provide sound information about the importance and safety of vaccinations.

'Parents should ask the right questions, but then they must be open-minded to the reality of the information, not the fear and misinformation that's out there, about things that have been proven wrong but are still in people's minds.'

In particular, he said, health officials can do a better job making the case for vaccinations to private school parents, who more often seek exemptions than public school parents.

Nationwide, 20 states allow for philosophical exemptions, totaling more than 36,000 during the 2011-12 school year.

Vermont legislators this year rejected a move to kill the philosophical objections, according to Chris Finley, immunization program manager with the Vermont Department of Health. Vermont reported 342 philosophic exemptions and nine for religious reasons, totaling 5.4 percent of all kindergartners, according to the CDC data. Medical exemptions pushed the overall rate to 5.7 percent.

The philosophical exemption 'gives a disease a greater chance to spread among a school or community,' Finley said.

Vermont this year recorded more than 300 cases of whooping cough, the largest outbreak in that state since the mid-1990s, she said. The wider exemption 'is definitely a contributing factor' because fewer people are protected, Finley said. The vaccine also has a waning immunity, meaning people are more likely over time to be susceptible to catching the disease, she said.

Finley urged that everyone 11 and older get vaccinated for whooping cough to protect themselves and others.

'You want to protect infants,' she said. 'It's a very dangerous bacterial infection for infants.'

Tim Soucy, Manchester's director of public health, said parents exercised 44 exemptions, including 34 on religious grounds. He said parents are much better at getting their children vaccinated today.

'Over the past 20 years or so, we've gone from 48 percent of 2-year-olds being fully immunized to more than 80 percent immunized,' Soucy said.

Farrah Deselle, co-leader of the Hillsborough County chapter of the Holistic Moms Network, which fosters awareness and provides information to support holistic parenting, said parents want choices.

'I would say (of) a significant percentage of our families that that's probably one of their top five things they struggle with: Do I vaccinate or not?' said Deselle, a registered nurse from Amherst.

The group's guest speakers in September and this month had vaccinations on their agendas, she said.

Deselle said a majority of its 75 to 80 chapter members back an exemption for conscientious beliefs. She said she lobbied lawmakers to back such a measure.

'Most of our members are at a minimum going to be under the belief families should have a choice of whatever their choosing for their children,' Deselle said. 'Definitely, parental autonomy is a big issue and vaccines fall under that category.'

She said many parents are skeptical about what's contained in vaccines and whether they can make their children sick.

'Again, I'm a registered nurse. I understand, but when I go back to what does our Constitution say, what's the intent of the Founding Fathers? It was for people to have the liberties to make the best choices for their families,' Deselle said. 'Vaccinations have a place in society, but we've taken it too far.'

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Mike Cousineau may be reached at mcousineau@unionleader.com. Union Leader reporter Ted Siefer (tsiefer@unionleader.com)contributed to this article.


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