What’s the Matter With Vermont?
Anti-vaccine activists derailed a bill that could have blunted the whooping cough epidemic.
Imagine coughing so hard and for so long that you turn blue and stop breathing. Pertussis, or whooping cough, can do that to an infant. The disease is caused by the bacterium Bordetella pertussis and occurs in three stages. The catarrhal stage, characterized by runny mucous, is highly contagious. It’s followed by the paroxysmal stage—unstoppable, sustained, violent coughing accompanied by a “whoop” when you inhale. (Listen to a baby with whooping cough here, or see a video of a boy with whooping cough here.) In the final, convalescent stage, a cough can linger for several weeks. Pertussis can affect anyone, but it poses the most danger to infants.
A pertussis vaccine became available in the 1940s, and incidence of the infection dropped from around 200,000 per year to barely over 1,000 by 1976. But today the United States is in the middle of a pertussis epidemic. According to the Centers for Disease Control and Prevention, more than 41,000 cases of pertussis were reported nationwide in 2012. At least 18 people have died, mostly infants younger than 3 months of age—too young to be fully vaccinated. There hasn’t been such a major outbreak since 1959. The states with the most cases per capita are Wisconsin, Minnesota, and Vermont.
The epidemic is due in part to the reduced effectiveness and the shortened duration of immunity conferred by a relatively new vaccine. But the epidemic is also spreading because of a low vaccination rate.
Vaccination needs a critical mass to effectively confer “herd immunity” on a population. When vaccine rates fall below 90 percent, diseases spread readily enough to endanger people who can’t be vaccinated because of illness or because they are too young. In parts of Vermont, the vaccination rate is only 60 percent. It is one of 20 states that allow a philosophical as well as religious exemption to vaccines, and it has one of the highest philosophical exemption rates in the country.
George Till, a state House representative and a physician, tried to change that last year by proposing a bill to eliminate the philosophical exemption to vaccines. Instead, Act 157, which became law on July 1—when the current pertussis epidemic was already raging—turned into a complicated, compromise vaccine bill that preserved the philosophical exemption.
Till lives and practices near Burlington, Vt., and was elected to the House four years ago. In his re-election campaign, he spent $18.55 for dog bones. With dog treats in hand, this soft-spoken doctor went door to door and asked his neighbors to vote for him. Till, an OB-GYN and a Democrat, did not accept donations to his campaign from any group—he even sent back a check from Planned Parenthood.
Act 157 originated when a pediatrician neighbor of Till’s came to him with a concern. In a local kindergarten class, 75 percent of students were not fully vaccinated. Till researched the issue and thought it was reasonable to get rid of the philosophical exemption in order to increase vaccination rates. Till proposed a bill in the House, and state Sen. Kevin Mullin proposed an almost identical bill in the Senate.
The Senate bill passed quickly, but not so in the House. Delays sometimes happen in Vermont’s “citizen legislature,” where lawmaking is a part-time endeavor by ordinary people for just 18 weeks of the year. The bill languished in the health care committee. Then the Legislature was off for a week because the first Tuesday in March is reserved for town meetings in communities across the state.
By the time the Legislature reconvened in the capitol building, the anti-vaccination community had organized itself. “They were in the building every day, in people’s faces,” Till says. The activists blared the discredited claims of Andrew Wakefield that vaccines do more harm than good, that vaccines cause autism. Wakefield, a British physician, was stripped of his medical license for fabricating a connection between vaccines and autism. Till could not believe what was happening: “He is God to these people.” Millions of lives have been saved through vaccines, numerous scientific studies have debunked the myth that vaccines cause autism, and the only studies to show a link have been exposed as frauds. Yet anti-vaxxers were successfully spreading misinformation.
The most egregious was their exploitation of the death of 7-year-old Kaylynne Matten of Barton, Vt. The anti-vaccine community claimed her death was due to adverse effects of the flu vaccine. However, the coroner listed the cause of death as complications from parainfluenza virus, a different category of virus from influenza.
State Rep. Warren Kitzmiller initially supported the bill in the House. He suffered from polio as a child, a terrible disease that regularly killed or crippled tens of thousands of children in the United States during an outbreak. Polio has been almost eliminated thanks to vaccines, but it persists in parts of the world because of suspicion about vaccines. After the anti-vax lobbying effort, Kitzmiller said that he could hardly remember his illness. He said he made a miraculous recovery. He voted against the bill.
Till could not even convince his own health care committee in the House that Vermont’s declining vaccination rates were a public health problem.
Kevin Mullin, Till’s co-sponsor of the bill, then proposed a compromise: placing a “trigger” into the vaccine bill so that if vaccination rates fell below 90 percent in any one school, the philosophical exemption would be eliminated for that school. But they could not get enough support for this provision, and it failed to appear in the final bill. The philosophical exemption stayed in place. When it came down to protecting newborns, the immune-suppressed, and children with special health needs, Till says, “This caucus threw the most vulnerable under the bus.”
Act 157 did mandate that parents refusing to vaccinate their children be required to receive educational material about vaccines and also to sign an exemption form acknowledging that they understood the risks to their children and others posed by their personal decision not to vaccinate. The Vermont Coalition for Vaccine Choice engaged an attorney, Mitchell Pearl, to challenge the language of the exemption form as unconstitutional. Pearl wrote in an open letter to the deputy commissioner of health, “signing the form is a violation of their rights under the First Amendment to the United States Constitution.” He threatened litigation if the Department of Health did not modify the exemption form’s language. The Health Department capitulated to the demands and neutralized the language of the form.
The Institute of Medicine recently issued a report about the safety of recommended childhood vaccines. The 14-member panel examined numerous studies, solicited feedback from many different groups, and found the current schedule of vaccines for children, which includes as many as 24 vaccines by a child’s second birthday, to be safe and effective: “The IOM committee uncovered no evidence of major safety concerns associated with adherence to the childhood immunization schedule.” The IOM acknowledged that some parents’ attitudes toward vaccines have “shifted,” largely driven by concerns about side effects, but said its report, which is the “most comprehensive examination of the immunization schedule to date,” should help reassure these parents. The IOM was clear: “Vaccines are among the most effective and safe public health interventions to prevent serious disease and death.” What’s more, “delaying or declining vaccination has led to outbreaks of such vaccine-preventable diseases as measles and whooping cough that may jeopardize public health.”
George Till is trying again to change the law in Vermont. He believes that the pertussis epidemic was preventable. “We had the chance to be proactive, but we blew it,” Till says. In January, he introduced new legislation in the House to eliminate in public schools both the philosophical and religious exemptions to the pertussis vaccine and to require adults who work with children to be current with their pertussis vaccination. The CDC is recommending that all adults, including pregnant women, receive a pertussis booster.
Schools and homes are where disease spreads. And in Vermont, Till says there are “pockets of unimmunized” posing a threat to their communities, especially in the “hot spots of anti-vaccination.” One such hot spot lies outside the capital, Montpelier. “These young parents were born in the vaccine era and have not seen devastating diseases,” he says. Till says these parents are “picking and choosing which vaccines they give to their children.” One of the vaccines these parents are most often choosing not to give their children is against polio.
Graphic by Natalie Matthews-Ramo