I want my form back.
I consider myself a thinking person, but sometimes I miss the obvious.
At the beginning of each school year, I drown in paperwork. It took me over an hour of solid writing just to fill out forms for two – two! – of my four kids for their elementary school teachers and office paperwork.
So I admit, when I get the vaccine exemption form, I fill it out just like any other form. Name, address, check this box, check that one, write “philosophical” on the “reason for exemption” line just like the school secretary told me, sign, date, done.
Now that there’s some renewed discussion about that form in the wake of a few rather major changes to the process parents use to obtain a vaccine exemption in Michigan, I realize that signing a document stating this:
By signing this waiver, you acknowledge that you are placing your child and others at risk of serious illness should he or she contract a disease that could have been prevented through proper vaccination.
…might not be the best paper trail to leave.
Am I in essence stating, “Yes, I am choosing to potentially harm my child?”
I can just imagine the Child Protective Services agent assigned to my wrongful case someday using that as a signed piece of evidence that I knowingly placed my child at risk.
Nope. Nope. Nope.
In our current world climate, I don’t think that’s paranoid at all. I can’t stop thinking about this poor mother who left her 4-year-old in the car on a mild day while she grabbed one item at a small store — and ended up arrested. I’m not going to put into writing whether I’ve ever done that before…but know that my hair stands on end thinking about having my kids taken away for something so minor.
It feels like a very short leap from a mindless form-filling-out session to a piece of evidence in a crazy CPS case against me where I’m losing my parental rights because I let them walk by themselves to the bus stop PLUS I didn’t vaccinate them.
But this post is not about me and mine.
It’s about the new rule changes on vaccine exemptions in the State of Michigan as of January 1, 2015.
And the real question is:
Who is breaking the law?
Me, or the state health department?
Michigan: Vaccine Exemption Easy Street
The vaccine exemption laws in Michigan used to be some of the most lenient, allowing for medical, religious, and philosophical objections.
The federal government creates no law that requires vaccinations, but all fifty states have their own requirements to enter school.
Forty-eight states allow for religious exemptions but only 20 include philosophical in the mix, so Michiganders had it pretty easy as far as avoiding vaccines if they wanted to. (source)
The average rate of vaccine exemptions in the nation is 1.8%, with massive differences in places like Mississippi, where only medical exemptions are allowed (less than 0.5% are not fully vaccinated) and Colorado, where nearly 20% of its population receives vaccine exemptions. (source)
As the calendar turned to 2015e still have the opportunity to utilize all three objections in Michigan, but there’s a lot more red tape.
Health Department Issues a New Vaccine Exemption Rule for Michigan
In late 2014, the state health department revised the Michigan Administrative Public Health Code to update a handful of procedures, like disease reporting by physicians, procedures for control of infectious diseases, confidentiality updates, rabies control…and some updates to the code on “immunizations required of children attending group programs or entering school.”
Now, for religious or philosophical exemptions, parents are required to “receive education on the risks of not receiving the vaccines being waived and the benefits of vaccination to the individual and the community.” They also have to use the official form, no substitutes as people could in the past.
The form of education is not specified – it could be a phone conversation, pamphlet, website, or even a chat with your doctor, as long as it’s approved by the local health department. My county’s health department website does not as of yet address this at all even though the “rule” (not law) went into effect January 1 of this year.
In other states that have added rules like this in recent years, Oregon last summer and Washington in 2011, multiple options are allowed. Colorado recently removed similar language from a bill; that state has the most vaccine exemptions in the nation.
In Washington in the last 3 years, vaccine exemptions have decreased 27% after the rule was put into effect, which is ultimately the goal our state is looking for – to increase the percentage of fully vaccinated kindergartners. (source)
Did the Health Department Step WAY Out of Bounds?
The real problems are not as much the additional hoops parents have to jump through to obtain an exemption – although more on that later – but the question of whether the state health department actually has the legal power to make this change without legislative or civilian comment or approval, as well as the issue of parental rights, and if this new rule is a slippery slope toward too much governmental control over our kids.
These rule changes included about a dozen points, all of which only affected physicians, health departments and schools, what they report and how and so on. This line item was the only one that would seriously affect the populace.
Unfortunately, I don’t know enough about legislative jurisdiction to unequivocally say that the health department officials seriously overstepped their bounds. I do know the same thing was attempted in Ohio at the same time and was offered for public opinion (and shot down), and the National Vaccine Information Center believes the board is culpable and the legislature should step in and repeal the rule. (source)
UPDATE: In 2007 the Attorney General discussed and explained the health department’s right to require a specific form for vaccine waivers.
Are Parents’ Constitutional Rights Undermined?
There also may be some 1st and 14th amendment rights violations going on in this rule change.
Right to Speech
The First Amendment is the one that guarantees the right to free speech – it’s why I can write this article without getting arrested, and it’s also why the government can’t go all Old Testament on me and force me to pledge allegiance to another god that is not my own.
Free speech includes the right not to speak, the guarantee that the government will not force people to say anything under penalty of law.
Yet my children could be denied their right to an education if I don’t sign something that (a) I don’t agree with and (b) could incriminate me.
Sounds like a tangled web to me!
Right to Parent
The Fourteenth Amendment’s due process clause guarantees “parents’ fundamental right to make decisions concerning the care, custody, and control of their children.” (as interpreted in Washington v. Glucksberg and Stanley v. Illinois, quoted from Alan G. Phillips, a North Caroline attorney)
This includes medical decisions, unless the state has already proven a parent is “unfit” to do the job completely. Kelly the Kitchen Kop contacted a lawyer and shared the full text of his opinions about the rule change in her vaccine exemption information post today, including this quote:
“When the state requires all parents to see educational material as a prerequisite to exercising the exemption, the state is presuming that all such parents are unfit to make the decision, without the required showing. On that basis, an educational requirement is unconstitutional and must be removed.”
The 14th Amendment is an occasional hotly debated topic in the news the last few years as cases of medical kidnapping crop up around the country – where the state removes children from their parents’ care either to force them to undergo a medical procedure doctors have deemed necessary, or because the parents are accused of “medical child abuse.”
Do parents have the right to turn down medical treatment for their children?
If you read an historical account of a parent forced to watch their 5-year-old son undergo the practice of “blood letting” where doctors used to put leeches on people to heal them from various maladies, wouldn’t you think it both bizarre and inhumane?
We have the benefit of hindsight in that one. We know that leeches did more harm than good and were at best, hokey, and at worst, dangerous.
Two hundred years from now, will people think the same thing when they read accounts of parents who wished to allow their son to avoid chemotherapy, a process by which toxic chemicals are injected directly into the bloodstream that make people feel very ill, make their hair fall out, and cause their immune systems to be severely compromised?
We have no way of knowing what hindsight will bring.
In healthcare, there are no absolutes, and there are often risks to both action and inaction.
Justina Pelletier’s story is even more chilling – the teenager was kept from her parents but for one hour a week and subjected to fifteen months of treatment at a Boston hospital. At the end of that time, she was returned to her parents, no better than when she started, and the doctors admitted they were wrong.
As I said – no absolutes.
Turn the Tables: Should the Parents be Prosecuted?
Those who believe vaccines are the only answer for widespread public health would turn the law against non-vaccinating parents in another way.
I found a really interesting legal debate where some say that, just as non-vaccinating parents believe it is an infringement up on their rights to be forced by the state to give vaccines to their child, parents of immune-compromised children who cannot receive vaccinations should be able to sue unvaccinated families for exposing their child to a greater risk. Some also say that unvaccinated children are such a great risk that they should be excluded from public places altogether, from schools to sidewalks. (source)
It’s all about torts. That’s just a great word to say, so it had to be included. [needed comic relief, right?]
There is an opposing viewpoint on the same site from a doctor of 30 years, who says basically that it’s nearly impossible to determine unequivocally the transmission source of any disease and certainly unfair and unfounded to sue for it. Parents of immune-compromised children and infants should keep them away from large populations of children to prevent their risk of many diseases, plenty beyond the vaccine-preventable ones. (source)
Another opposing viewpoint states that using tort law to go after non-vaccinating parents would cause community disunity and not solve problems, although it might be fair. (source)
We in Michigan should be grateful that we have philosophical exemptions to required vaccinations as we are one of only 20 states that do, so this new rule is a better alternative than the state simply stripping it down to only medical exemptions or medical and religious exemptions allowed.
There are six other states requiring vaccine education as a prerequisite to submitting a waiver. The health department stated the reasons for Michigan adding this requirement:
“Vaccine waivers are sometimes signed for reasons other than the intended purposes of the waivers. When this happens it leaves the Michigan population at risk of vaccine preventable diseases if too many individuals remain unvaccinated. The rule does not eliminate any authority provided in the Public Health Code to sign a waiver. This rule merely assures that people are educated on the risks to their children and the individuals around them if they decide not to vaccinate.” (source: downloadable PDF)
So we have to get our “education” on this subject certified. It’s my hope that anyone exempting for philosophical reasons has already done exhaustive research, so your mind is likely quite made up, and it’s just a hoop to jump through.
It’s annoying, but not killer.
Social science shows that the education requirement won’t change most people’s minds, (source) so the state’s goal with this isn’t to solve the vaccine debate, but to put up a roadblock for the non-thinking, non-educated parents who are just opting out because it’s easier.
Those parents, who are hopefully few and far between, ought not be opting out anyway if they’re not willing to do the research.
The fact remains that freedoms have been tightened, perhaps even violated, with this new rule – which in itself may or may not have been a legal move by the state health department.
The National Vaccine Information Center released a statement including:
“In Michigan, state health officials abused their rule making privileges and failed to adequately inform the public and solicit feedback from families negatively impacted by restriction of non-medical vaccine exemptions.” (source)
Why so Sneaky?
If the health department was underhanded in this, we must ask why they thought the changes were necessary in the first place.
Likely the rule revisions are in response to a few recent issues:
- The increase in non-medical exemptions in the state from 2% to 6% in recent years.
- The very recent outbreaks of whooping cough in Grand Traverse and Allegan Counties.
A few notes so you know all the sides of the story…
It’s likely that the increase in exemptions was caused by one specific vaccine added to the required list in 2010: a second round of varicella. Many parents exercise caution with their children when brand new rules (and relatively new vaccine formulas) are mandated.
The statistics on exemption are not recorded based on how many vaccines a parent chooses to opt out on, only which children are not completely vaccinated.
As for the pertussis outbreaks, there are a few confounding factors in the quest to pin them squarely on the heads on unvaccinated or partially vaccinated families:
- The Allegan cases were all or nearly all in teenagers who had received their full dosing of pertussis vaccines. (source)
- The Traverse City outbreak did include many children who were unvaccinated against the disease, (source) but the reporting may have been less than ideal.
How do I know that?
A friend from Traverse City, whose children attend one of the nearly two dozen schools involved, shared some information with me:
- Not all cases were documented. Kids who were showing symptoms were often simply given antibiotics rather than being tested, since whooping cough or pneumonia or a respiratory infection would all have the same treatment. Surely many cases were missed – dare I say especially in vaccinated individuals?
- Children in affected schools were told to get prophylactic antibiotics – so again, many kids who probably had pertussis treated it early without being tested and were not counted in the official totals. Plus, parents who don’t vaccinate are probably more likely to avoid preventative antibiotics, so those kids are more likely to have been officially diagnosed instead of passed over because they were not (or not very) symptomatic.
- This does NOT follow the CDC guidelines for an outbreak of pertussis as outlined here, which recommends active screening of suspected cases and limited, targeted use of preventative antibiotics.
It is my strong opinion that the statistics publicized in the Traverse City whooping cough outbreak are confounded by inaccuracies and should have no bearing on any sort of discussion or legislation on vaccines and vaccine-preventable diseases. The health officials there did not attempt to accurately track the progression of the contagion, and an excellent opportunity for learning was missed.
And believe me, I know a little bit about disease reporting since I called the health department to report my own kids after the doctor refused to.
What Will the New Rule REALLY Look Like?
I called the health department to find out.
On January 15, 2015, they had just had their training session that afternoon, so my timing was perfect.
Here’s what I learned:
- Parents opting out of any vaccines need to go in person, with an appointment, to the health department. (This is only required as they enter Kindergarten, 7th grade, or switch school districts plus every year in daycare. Some school require a form every year, but that’s their individual requirement and totally different.)
- The health department will fill out the form after they’ve shared their information with you (much of which is from Children’s Hospital of Pennsylvania, or “CHOP.” Kent County is working on coming up with its own materials. One of the reasons for this new guideline is to unify the educational materials people get. (But..then why vary by county???)
- The parent needs to explain their reasons for each vaccine they are opting out of. It doesn’t need to be super in depth, just “this ingredient…” or “this side effect…” or whatever your reason is.But it’s much more extensive than the old way, which was to write “philosophical” or “religious” — just one word only, nothing else, our school secretary tells me curtly every year. They’ll write those down, and it gives them a chance to address parents’ concerns directly, to “make sure the information people are getting is good.”
- UPDATE: This is Kent County but NOT in any way in the actual state rule. If you are asked to provide reasons, you do not need to.
- The parent has to use the form from the state dated 1/1/15 and must not alter it in any way. I asked what would happen if one did cross out “that phrase” that feels so criminalizing, and she said your child might not be allowed at school.
- UPDATE: I just learned that the new form, dated 1/1/15 and with Nick Lyon as the health department director, will state: “By signing this waiver, I acknowledge that I have been informed that I may be placing my child and others at risk of serious illness should he or she contract a disease that could have been prevented through proper vaccination.” (Source: email from health department to members of the Michigan Families for Vaccine Freedom group)
- My opinion? Still not very parent-friendly, but maybe less incriminating? And with a 72% effective rate on, say, the pertussis vaccine, could we really prevent those illnesses through proper vaccination?
I have a 3-year-old who will be starting preschool next year, and he’s nowhere near “on schedule” for his vaccinations. He’s already immune to pertussis, for example, so no need for that one anymore.
We’re still making decisions month by month, vaccine by vaccine, child by child.
I have no idea what I’ll do when it comes to signing that form in September. I don’t feel it’s legally prudent to allow the line about “putting my child at risk” to have my signature on it.
But if I don’t, John might not be able to go to preschool, and I think he’d thrive there.
In the end, I hope that something changes by then, and I’ll be taking some action steps to let my democratic voice be heard.
Call to Action: Be the Change
If parents in Michigan want to help get this rule rescinded, there are some action steps they can take:
- Get on the newsletter list for Michigan Opposing Mandatory Vaccines to stay up to date.
- Sign up for the NVIC Advocacy portal and be ready for them to send a Michigan “action alert” telling you what to do: http://NVICAdvocacy.org
- NVIC is also collecting as many Michigan stories of vaccine reaction, harrassment, and failure as possible.
- You can always call or write your legislators directly, asking them to initiate action to remove the rule put in place by the state health department (R 325.176 of the Michigan Administrative Code) in December of 2014. Contact information for state senators and representatives is available. Many are just being sworn in to state office for the first time, so they might need some education on what you’re even talking about! Keep in mind that what you’re asking is not to enter debate on whether vaccines are necessary, effective, or anything else – just that (a) the health department did not invite public comment and should, and (b) parents should retain the right to be exempt from mandatory vaccinations.
Whether you’re in Michigan or not, I’d love to open up the floor for (polite, respectful) conversation about the issue of medical parental rights.
What do you think? What would you do?
A few other West Michigan bloggers are ringing in on the subject today. If the post isn’t live yet, check back and it will be soon:
- Donielle from Natural Fertility and Wellness
- Kelly the Kitchen Kop
- Adrienne from Whole New Mom
- Melissa from Integrative Nutritional Therapies
Disclaimer: I am not a medical professional and nothing in this post should be taken as medical (or legal!) advice.
Photos are from GraphicStock.com. Used with permission.