The new law would make it harder for parents to opt out of vaccinating their children against the measles
The Washington Post
The Washington state Senate narrowly passed a measure Wednesday night that would make it harder for parents to opt out of vaccinating their children against the measles in response to the state’s worst measles outbreak in more than two decades.
The bill, which would eliminate personal or philosophical exemptions from the measles, mumps and rubella vaccine, is a big win for public health advocates who had not expected it to make it to the floor.
It passed 25-22 in the Democratic-controlled chamber, after being brought to the floor just minutes before the legislative deadline. No Republicans voted in favor, and two Democrats voted against.
The bill is expected to pass the House, where a nearly identical measure was approved last month, and be signed into law by Democratic Gov. Jay Inslee. It would be the first time in four years that a state has removed personal exemptions in the face of growing anti-vaccine sentiment. California and Vermont removed personal exemptions in 2015. Other states have taken measures to tighten various vaccine requirements but not remove the exemptions.
The bill’s 11th-hour passage in the state Senate comes as the resurgent disease approaches record numbers and other states weigh similar legislation to close loopholes or eliminate personal or religious exemptions from vaccination requirements.
Inslee, who pushed lawmakers to support the measure, is also running for president on a platform centered on evidence-based science and climate change. The vaccine debate has pitted advocates of science and public health, who reflect the majority of Americans who support vaccinations, against a minority of anti-vaccine activists, who raise concerns about personal choice and vaccine safety, most of which have been debunked.
The stricter rule would apply only to immunizations for measles, mumps and rubella. Parents would continue to be able to cite personal or philosophical exemptions to avoid other required school vaccinations for their children. Religious and medical exemptions will still be allowed for all vaccinations, including MMR.
Advocates and lawmakers were able to overcome strong lobbying by anti-vaccine groups, which are among the most vocal and organized in the country. Those groups mobilized hundreds of supporters, who telephoned and sent emails to lawmakers, turned out for public hearings and proposed poison-pill amendments.
Republicans had proposed more than a dozen amendments to weaken the bill and appeared to be close to killing it before a last-minute flurry of action.
State Sen. Annette Cleveland, the Democrat who sponsored the bill, spent more than two hours during the floor debate Wednesday night refuting misinformation about the safety of the measles, mumps, and rubella (MMR) vaccine and measles’ risk for children. She told colleagues that a vote against the bill would be “a vote against public health, a vote against the safety of our public spaces.”
After the measure passed, she referred to the “unfortunate reality today that many people embrace conspiracy theories and alternative facts more readily than proven science.”
In a statement to The Washington Post, she added: “It’s even more disappointing when you hear colleagues across the aisle share their constituents’ unsubstantiated Internet theories over the expert knowledge of our country’s best medical minds at the Centers for Disease Control and Prevention.”
Republican senators opposing the measure spoke repeatedly about government overreach. “I really believe parents should have the right to decide what type of medical procedures to use on their children, and that’s especially true of little ones,” said state Sen. Mike Padden.
Immunization advocates were overjoyed by the bill’s passage.
“We are elated!” said Sarah Rafton, executive director of the Washington chapter of the American Academy of Pediatrics.
Rupin Thakkar, president of the AAP chapter, blamed dangerous measles outbreaks on the rise of vaccine exemptions for personal beliefs and applauded the legislature for eliminating them. “The recent measles outbreak served as an alarm, and today our legislators bravely stood with facts over fiction.” he said.
Other state and local efforts to control outbreaks are also encountering resistance from those opposed to mandatory vaccinations: In New York City, a group of parents brought a lawsuit Monday against the Board of Health’s order to vaccinate everyone in four hard-hit Zip codes in Brooklyn, home to tens of thousands of ultra-Orthodox Jews and the locus of 329 measles cases. But in a meeting Wednesday, New York City’s health board voted unanimously to extend that order, although efforts in the state capital to tighten vaccination laws appeared unlikely to move.
On Tuesday, officials in Rockland County, New York, barred all unvaccinated people who had been exposed to the disease from public gathering places, including houses of worship, for up to three weeks. “Need we wait for someone to die?” Rockland County Executive Ed Day said in announcing the measure.
Simultaneous campaigns to toughen state requirements in Iowa, Colorado, Maine and Oregon also face strong opposition, although it remains unclear what, if any, impact Washington’s success might have on lawmakers in those states. Washington is one of 17 states that allow exemptions from required immunizations for personal or philosophical beliefs.
In Washington, the outbreak prompted Inslee to declare a state of emergency Jan. 25 after officials reported 25 measles cases. As the numbers shot up – 78 measles cases in Washington and neighboring Oregon have been confirmed, among 555 cases nationwide across 20 states – lawmakers in Olympia began weighing legislation to eliminate personal or philosophical exemptions.
If the outbreaks are not brought under control, health officials worry that measles cases in 2019 will set an all-time high nearly two decades after the vaccine-preventable respiratory disease was “eliminated” in the United States. Before vaccines were introduced, measles sent tens of thousands of Americans to hospitals each year and killed an estimated 400 to 500 people, many of them young children.
Public health officials had worried the bill was headed for defeat, which would have suggested “a very vocal minority has a disproportionate amount of influence on an issue that impacts everybody,” said Michael Fraser, chief executive for the Association of State and Territorial Health Officials.
“We need to look at the tactics used by opponents to better understand how these could play out in other states, and address those issues head on anticipating similar arguments,” he added after the vote.
Rafton said there is broad public support for the safety and efficacy of childhood vaccinations, noting that 98 percent of children in the United States are immunized. But in Washington, the state’s vaccination rate for kindergarten-age children for the 2017-18 school year was 86 percent – well below the 95 percent state target to effectively prevent the spread of most diseases.
About 4.7 percent of Washington kindergartners claimed an exemption to at least one vaccine – over twice the national rate, according to state Health Department data for 2017-2018.
Nearly 9 of 10 children with nonmedical exemptions claimed personal or philosophical reasons.
Republican Rep. Paul Harris sponsored the measure that passed the state House last month, after a similar measure failed several years ago. His district in Clark County is at the center of the outbreak, just north of Portland, Oregon. He cited overwhelming support for a high level of community immunity to protect children, pregnant women and people with compromised immune systems who can’t get vaccinated.
But until Wednesday, the bill’s supporters were not optimistic about its chances. A handful of Democratic senators had been uncomfortable with the measure, said Rafton. “One senator has been hesitant because a family member had a reaction to a vaccine,” she said.
Last-minute maneuvering allowed the bill to be called for a vote. A procedural motion nearly derailed the vote, which was further delayed by a fire alarm that forced evacuation of the chamber. Throughout the evening, Republican senators proposed 18 amendments to delay, weaken or alter the bill, all of which were either withdrawn or defeated. One amendment would have lessened protection for the youngest children, who are most at risk for serious complications of measles.
In the weeks leading up to the debate, the medical community was at a disadvantage, Rafton said, because it was unable to mobilize the same kind of physical presence at hearings and in meetings with legislators as the anti-vaccine activists, she said.
Medical groups didn’t want to have “doctors and parents facing off in the hallways,” she said. As a result, “we haven’t been able to represent our members with that same sort of palpable presence, despite pediatricians’ clear opinions that the law should change.”
Doctors also want to keep a dialogue going with “the parents who worry and wonder about getting shots,” she said. “So we want to take the high road in advocacy. We find when doctors are thoughtful and truly listening to parents, over time, they’re able to get the right information.”